I. De Castro Silva1, L. Wo1, K. Y. Xu1, J. R. Mella Catinchi1 1University Of Miami, Plastic Surgery/Surgery, Miami, FL, USA
Introduction: The incidence of lymphedema following axillary lymph node dissection may be as high as 65%. Lymphatic microsurgical preventive healing approach (LYMPHA) may reduce this risk to < 5%. During axillary dissection, all lymphatic contents between the pectoralis major and minor, the latissimus dorsi posteriorly, the serratus anterior medially and the axillary vein cephalad are removed. While efforts are made to preserve the long thoracic nerve and thoracodorsal neurovascular bundle, venous tributaries from the axillary veins are often proximately ligated, which adds to the challenge of finding appropriate veins for LYMPHA. Any vein with a caliber > 1mm and adequate length to reach lymphatic channels could be a suitable option for LYMPHA, but they are poorly characterized anatomically. The aim of this study is to identify and describe tributaries of the axillary vein that can be preserved during axillary dissection and utilized during lymphovenous bypass.
Methods: A total of four female cadavers, totaling eight axilla were evaluated (Fig). All veins with a diameter >1mm found within the boundaries of a usual surgical axillary dissection were identified, preserved, and traced back to the axillary vein. The distance between the sternal notch (SN) and acromioclavicular joint (ACJ) was measured and used as a line of reference. Locations of branching veins were described using axillary vein and thoracodorsal vein as reference points.
Results:Two veins, thoracoepigastric vein (Branch A) and intercostal tributary to the axillary vein (Branch B), were found to branch from the axillary vein in all axillas. These branches were located at a mean of 11.9 cm (Branch A) and 10.6 cm (Branch B) lateral to the sternal notch. The average caliber of the Branch A was 2.16 +/-0.68 mm and at 55% distance projected from SN. In 66% cases, it bifurcated into two branches 4.38 cm away from the axillary vein. Branch B had an average caliber of 2.29 +/- 0.21 mm and at 52% distance projected from SN. In 83% of the cases, branch B bifurcated into two branches 3.26 cm from the axillary vein.
Conclusion:The thoracoepigastric vein and intercostal tributary to the axillary vein are excellent venous options for creation of a lymphovenous bypass using the LYMPHA technique. Moreover, preservation of bifurcation points may allow for multiple bypasses into a single vein. Improved knowledge of axillary venous anatomy can guide the preservation of suitable options for LYMPHA during axillary dissection.
