Successful Mapping of Lymphorrhea Using Patent Blue Dye after Lymph Node Dissection for Malignant Melanoma

Abstract

Patent blue is a dye that has been used for intraoperative lymphatic mapping. We used this mapping method on a patient with lymphorrhea after groin dissection. We easily detected the lymphatic channel causing lymphorrhea and successfully ligated it. This technique may have great merit for treating of lymphorrhea.

Intraoperative mapping with isosulfan blue of lymphatic leakage during inguinal lymph node dissection (ILND) for skin cancer for the prevention of postoperative lymphocele

“…Isosulfan blue dye is taken up selectively by the lymphatic system and used for sentinel node biopsy in patients with cutaneous melanoma, other cutaneous malignancies, breast cancer, and thyroid cancer 11–14, 29. Recently, it has also been used to identify and ligate the injured lymphatics causing lymphoceles that result from femoral vessel cannulation for cardiopulmonary bypass, arterial bypass and cardiac catheterization procedures, resection of malignant groin tumors, and ILND 15–17. In our study, we postulated that intraoperative use of isosulfan blue for identification of injured lymphatics during ILND would prevent postoperative lymphocele.…”

“…Isosulfan blue is currently used for sentinel node evaluation in patients with cutaneous melanoma, breast cancer, or thyroid cancer 11–14 and is effective in delineating the course of lymphatic channels. Isosulfan blue is a safe and easy‐to‐use agent that has few side effects and has also been used to identify and treat lymphoceles arising from lymphatics injured during surgery of the groin region such as during femoral vessel cannulation, saphenous vein harvesting, tumor excision, and ILND 15–17. However, the preventive use of dye at the time of ILND has not been reported.…”

Successful treatment of refractory hepatic lymphorrhea after gastrectomy for early gastric cancer, using surgical ligation and subsequent OK-432 (Picibanil) sclerotherapy

“…The most effective therapy for intractable lymphorrhea appears to have been surgical ligation of lymph fistula with supportive sclerotherapy and/or fibrin glue sprinkle. Even if the preoperative imaging study does not show an obvious leakage point, surgical ligation should be performed, together with intraoperative injection of dye such as patent blue violet [24].…”