Grants We Funded

Abstract
Lymphedema is a chronic disease of the lymphatic system which is in charge of the drainage of lymph, a fluid that prefentially contains macromolecules as well as the cells that fight infection throughout the body. The most common cause of lymphedema is removal of lymph nodes at the time of the breast cancer surgery. This operation disrupts the function of the lymphatic system, predisposing patients to lymphedema. Once lymphedema has developed, there is no known cure, making it one of the most significant cancer survivorship issues of breast cancer patients. A recent surgical advancement has demonstrated promising results in preventing lymphedema by re-connecting divided lymphatic channels to veins immediately after lymphadenectomy to restore the normal lymph flow. Despite early promising results, this technique has never been studied in the laboratory due to a lack of an objective and reproducible way to measure the lymph flow after re-connecting the remaining lymphatic channels to the venous system. Our proposal involves a study in a swine model where we will measure the real time flow of lymph from a pig's hind limb after removal of lymph nodes with and without re-connecting the lymphatic system to the venous system. To do so, we will use, for the first time, FDA approved dyes that “glow” the lymph so that we measure the amount of dye that reaches the venous system. Our main goal is to establish the role of these molecular dye agents for measuring real time lymphatic flow. To accomplish our proposal, we will divide our pigs into three groups: (1) we will perform a lymphadenectomy in the study limb and no surgery will be performed in the contralateral limb (control); (2) we will remove the lymph nodes in the study limb and re-connect one lymphatic channel to a vein while the control limb will remain untouched; (3) we will remove the lymph nodes in the study limb and re-connect two lymphatics to a vein, the control limb will remain untouched. After these procedures are performed, we will inject different dyes into each limb to measure the clearance of each dye from the central venous system. We expect to find optical imaging to be accurate and reproducible in measuring lymphatic clearance of a limb. Moreover, we predict the lymph will reach the venous system faster when more lymphatic channels are reconnected to veins. By validating this methodology, we will be a step closer to developing a clinically applicable objective measure of lymphatic function.

Biography
My major research contribution has come in the field of microsurgery, including lymphatic surgery. During my residency, I developed the concept of hydrodissection for microsurgical perforators. I further developed this idea during my post-residency education where I worked on two projects using animal models to further study and understand the limitations of this technique. Since then, I have published four manuscripts on this topic including two animal studies. This technique has been invited for presentation at multiple national meetings and continues to be utilized at major national and international academic centers. For lymphatic surgery, I developed a novel method of intraoperative lymphatic channel visualization utilizing a formulation of fluorescein. This is an important innovation because prior imaging techniques did not allow for simultaneous imaging and dissection of vessels. I am currently presenting this work regionally and nationally. While the lymphatic surgery world continues to focus on treatment of chronic lymphedema, I am one of a handful of pioneers working on eliminating the disease by performing procedures to re-route the lymphatic system at the time of the cancer procedure. My goal is to eradicate lymphedema caused by cancer extirpations. With further refinements in surgical technique combined with potential augmentation with cytokines that increase lymphatic vessel growth, I believe we can eliminate one of the largest issues in cancer survivorship.