Objective: To review the current progress of clinical and experimental research of vascularized lymph node transfer for lymphedema. Methods: The domestic and abroad literature about vascularized lymph node transfer in treatment of lymphedema was reviewed and analyzed. Results: Experimental studies in animal model indicate that vascularized lymph node transfer can improve lymph node survival and show a promising effectiveness in reducing lymphedema. "Lymphatic wick" and "lymph pump" were the two main hypotheses proposed to explain the potential functional mechanism of vascularized lymph node transfer in treatment of lymphedema. Improvement in lymphedema symptoms are reported in most of the clinical trials, but the level of evidence to advocate this procedure in the treatment of lymphedema remains low because of the small number of the cases and problems in their methodologies. Conclusion: Based on current evidence, vascularized lymph node transfer seems to be a promising treatment for lymphedema, but long-term well-designed studies are required to further explore the effectiveness of this procedure.

Objective:To establish an animal model of secondary chronic lymphedema using rabbit hind limb and evaluate it with indocyanine green (ICG) lymphangiography.Methods:From March 2017 to March 2018, a secondary lymphedema model of rabbit hind limb was established in 7 rabbits in the Animal Experimental Centre of Peking University People's Hospital. The right hind limb of the rabbit was the control side, and the left hind limb was the experiment side which using simple surgical induction (dissection of inguinal lymph nodes, removal of lymph tissue around femoral vessels, and circumferential removal of subcutaneous tissue in 5.0 cm wide). Measurement of limb circumference and volume, ICG lymphangiography and histology were applied to evaluate the rabbit model 24 weeks after surgery. Continuous variables were presented as Mean±SD, the differences were compared using Student t test. Use the count data case (%) to represent it. All statistical analyses were performed using SPSS software version 26.0. A two-sided P<0.05 was considered statistically significant. Results:Among 7 female New Zealand white rabbits, 1 died in modeling, 5 of the remaining 6 rabbits developed lymphedema (83.3%) (5/6) at 24 weeks after surgery. Impaired structure and function of lymphatic vessels was found in all the rabbits. Circumference and volume of the experimental hind limbs tended to be stable at 20-24 weeks after surgery, and the circumference at 2 cm above knee on the experiment side (17.58 cm±0.23 cm) was greater than that on the control side (16.65 cm±0.47 cm) at 24 weeks after surgery with statistical significance ( P<0.01). The circumference of knee on the experiment side (15.23 cm±0.47 cm) was greater than that on the control side (14.42 cm±0.51 cm) with statistical significance ( P=0.018). The circumferences at the plane of middle calf, ankle, middle foot, and volume on the experimental side were all greater than those on the control side, without statistical significance. At 24 weeks after surgery, ICG lymphangiography showed that all 6 affected hind limbs of the rabbits had morphological changes of lymphatic vessels, lymphatic fluid stasis and dermal backflow. Of the experiment limb, hyperplasia was found in the keratinised layer with thickened dermis, increased number and dilated subcutaneous lymphatic vessels, as well as a fibroplasia. However, no collecting lymphatic vessel was observed around the femoral arteries and veins. Conclusion:Simple surgical method can induce a secondary chronic lymphedema in rabbit hind limb, and it can be effectively evaluated by the ICG lymphangiography.

Microsurgery techniques have allowed the development of many new therapeutic methods in plastic surgery, but are difficult to master without hard training. It is very important to set up a standardized microsurgery curriculum and training system for broadening surgical skills training and investigating the plastic surgery specialist training strategy. In our experiences, a series of training models are needed, like non-animal models, non- living animal models, live animal models and so on. This paper shows the training strategy for the primary stage of microsurgery training, non-animal model and non-living animal model training.

Microsurgery techniques have allowed the development of many new therapeutic methods in plastic surgery, but are difficult to master without hard training. It is very important to set up a standardized microsurgery curriculum and training system for broadening surgical skills training and investigating the plastic surgery specialist training strategy. In our experiences, a series of training models are needed, like non-animal models, non- living animal models, live animal models and so on. This paper shows the training strategy for the primary stage of microsurgery training, non-animal model and non-living animal model training.

Objective:To investigate the clinical features of primary intestinal lymphangiectasia (PIL).Methods:This study was a retrospective case series study. Fifty consecutive patients diagnosed with PIL in Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from March 2019 to March 2021 were included and their clinical data was retrospectively reviewed. There were 20 males and 30 females included, with an age of ( M(IQR)) 14 (40) years (range:0 to 67 years). No patient had the family history. There were 26 children, including 9 males and 17 females, aged 0 (7) years (range:0 to 14 years). There were 24 adults, including 11 males and 13 females, aged 40 (26) years (range:20 to 67 years). The clinical manifestations and the results of laboratory examinations, gastrointestinal endoscopy, 99Tc m-labeled human albumin ( 99Tc m-HSA) scintigraphy, 99Tc m-DX scintigraphy, direct lymphangiography (DLG), histopathology, diet treatment, surgical intervention, and clinical symptom remission at discharge were collected. Comparisons between groups were performed using independent samples t-test, Mann-Whitney U test, or χ2 test. Results:Among the 50 cases of PIL, the main manifestations were edema (86.0%), diarrhea (76.0%), and abdominal effusion (48.0%). Lymphedema (36.0%) and chylous ascites (18.0%) were not rare in PIL patients. In 99Tc m-HAS scintigraphy, 95.9% (47/49) cases showed signs of intestinal protein loss, and 91.7% (44/48) ceses showed positive findings in 99Tc m-DX scintigraphy. In DLG, 97.8% (45/46) cases showed signs of thoracic duct obstruction, 82.6% (38/46) cases showed retroperitoneal lymphatic hyperplasia, and 23.9% (11/46) cases showed backflow of contrast agent into intestine. No significant difference was seen in gender, course of disease, clinical manifestation, serum level of albumin or globulin, lymphocyte count, positive rate of fecal occult blood and prevalence of lymphedema between adults and children (all P>0.05). Conclusions:The clinical presentations of PIL between children and adults had no significant difference. The diagnosis of PIL should be made according to clinical manifestation, 99Tc m-HAS scintigraphy, 99Tc m-DX scintigraphy, DLG, gastrointestinal endoscopy and pathological findings.

Objective:To investigate the clinical features of primary intestinal lymphangiectasia (PIL).Methods:This study was a retrospective case series study. Fifty consecutive patients diagnosed with PIL in Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from March 2019 to March 2021 were included and their clinical data was retrospectively reviewed. There were 20 males and 30 females included, with an age of ( M(IQR)) 14 (40) years (range:0 to 67 years). No patient had the family history. There were 26 children, including 9 males and 17 females, aged 0 (7) years (range:0 to 14 years). There were 24 adults, including 11 males and 13 females, aged 40 (26) years (range:20 to 67 years). The clinical manifestations and the results of laboratory examinations, gastrointestinal endoscopy, 99Tc m-labeled human albumin ( 99Tc m-HSA) scintigraphy, 99Tc m-DX scintigraphy, direct lymphangiography (DLG), histopathology, diet treatment, surgical intervention, and clinical symptom remission at discharge were collected. Comparisons between groups were performed using independent samples t-test, Mann-Whitney U test, or χ2 test. Results:Among the 50 cases of PIL, the main manifestations were edema (86.0%), diarrhea (76.0%), and abdominal effusion (48.0%). Lymphedema (36.0%) and chylous ascites (18.0%) were not rare in PIL patients. In 99Tc m-HAS scintigraphy, 95.9% (47/49) cases showed signs of intestinal protein loss, and 91.7% (44/48) ceses showed positive findings in 99Tc m-DX scintigraphy. In DLG, 97.8% (45/46) cases showed signs of thoracic duct obstruction, 82.6% (38/46) cases showed retroperitoneal lymphatic hyperplasia, and 23.9% (11/46) cases showed backflow of contrast agent into intestine. No significant difference was seen in gender, course of disease, clinical manifestation, serum level of albumin or globulin, lymphocyte count, positive rate of fecal occult blood and prevalence of lymphedema between adults and children (all P>0.05). Conclusions:The clinical presentations of PIL between children and adults had no significant difference. The diagnosis of PIL should be made according to clinical manifestation, 99Tc m-HAS scintigraphy, 99Tc m-DX scintigraphy, DLG, gastrointestinal endoscopy and pathological findings.