LETTER TO THE EDITOR
MICROSURGERY 35:335–336 (2015)
SIMPLE WIRE RETRACTOR FOR SUPERMICROSURGICAL LYMPHATICOVENULAR ANASTOMOSIS Dear Editor,
Supermicrosurgical
lymphaticovenular anastomosis (LVA) is becoming a useful treatment option for lymphedema with its less invasiveness and effectiveness.1,2 Although preoperative imaging methods such as indocyanine green lymphography facilitates successful LVA, it is not easy to manipulate lymphatic vessels in the deep fat layer.3–5 We often need a retractor to gain enough space. A conventional surgical retractor is useful for better visibility of a surgical field, but would disturb a surgeon’s supermicrosurgical procedures with its long handle. To resolve the drawback, we developed an original retractor made from a conventional K-wire. A 0.8 mm K-wire is bent with a pair of pliers to fit the width and the depth of the surgical site of LVA; usually, 3 3 3 3 3 cm3 is useful for LVA (Fig. 1A). Our retractor has several advantages; 1) easy to create; 2) low cost with reusability; and 3) no long handle that may disturb a surgeon’s procedures (Fig. 1B). MOTOI KATO, M.D.* AND TAKUMI YAMAMOTO, M.D. Department of Plastic and Reconstructive Surgery Tokyo University, Tokyo, Japan
*Correspondence to: Dr. Motoi Kato, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655. E-mail: [email protected] Received 21 May 2014; Revision accepted 9 July 2014; Accepted 8 August 2014 Published online 23 August 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/micr.22310 Ó 2014 Wiley Periodicals, Inc.
Figure 1. (A) Our retractor is easy to create, and low cost with reusability. (B) No long handle that may disturb procedures.
336
Letter to the Editor
ACKNOWLEDGMENTS
The authors thank Dr. Kenjiro Hasegawa for providing a valuable insight that led us to establish this retractor. Accordingly, we would like to call the retractor a “Hasegawa retractor.”
REFERENCES 1. Yamamoto T, Narushima M, Yoshimatsu H, Seki Y, Yamamoto N, Oka A, Hara H, Koshima I. Minimally invasive lymphatic supermicrosurgery (MILS): Indocyanine green lymphography-guided simultaneous multi-site lymphaticovenular anastomoses via millimeter skin incisions. Ann Plast Surg 2012;72:67–70.
Microsurgery DOI 10.1002/micr
2. Yamamoto T, Yoshimatsu H, Narushima M, Seki Y, Yamamoto N, Shim TW, Koshima I. A modified side-to-end lymphaticovenular anastomosis. Microsurgery 2013;33:130–133. 3. Yamamoto T, Narushima M, Doi K, Oshima A, Ogata F, Mihara M, Koshima I, Mundinger GS. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: The generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconst Surg 2011;127:1979– 1986. 4. Yamamoto T, Yamamoto N, Azuma S, Yoshimatsu H, Seki Y, Narushima M, Koshima I. Near-infrared illumination systemintegrated microscope for supermicrosurgical lymphaticovenular anastomosis. Microsurgery 2014;34:23–27. 5. Yamamoto T, Yamamoto N, Numahata T, Yokoyama A, Tashiro K, Yoshimatsu H, Narushima M, Koshima I. Navigation lymphatic supermicrosurgery for the treatment of cancer-related peripheral lymphedema. Vasc Endovasc Surg 2014;48:139–143.
MICROSURGERY 35:335–336 (2015)
SIMPLE WIRE RETRACTOR FOR SUPERMICROSURGICAL LYMPHATICOVENULAR ANASTOMOSIS Dear Editor,
Supermicrosurgical
lymphaticovenular anastomosis (LVA) is becoming a useful treatment option for lymphedema with its less invasiveness and effectiveness.1,2 Although preoperative imaging methods such as indocyanine green lymphography facilitates successful LVA, it is not easy to manipulate lymphatic vessels in the deep fat layer.3–5 We often need a retractor to gain enough space. A conventional surgical retractor is useful for better visibility of a surgical field, but would disturb a surgeon’s supermicrosurgical procedures with its long handle. To resolve the drawback, we developed an original retractor made from a conventional K-wire. A 0.8 mm K-wire is bent with a pair of pliers to fit the width and the depth of the surgical site of LVA; usually, 3 3 3 3 3 cm3 is useful for LVA (Fig. 1A). Our retractor has several advantages; 1) easy to create; 2) low cost with reusability; and 3) no long handle that may disturb a surgeon’s procedures (Fig. 1B). MOTOI KATO, M.D.* AND TAKUMI YAMAMOTO, M.D. Department of Plastic and Reconstructive Surgery Tokyo University, Tokyo, Japan
*Correspondence to: Dr. Motoi Kato, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655. E-mail: [email protected] Received 21 May 2014; Revision accepted 9 July 2014; Accepted 8 August 2014 Published online 23 August 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/micr.22310 Ó 2014 Wiley Periodicals, Inc.
Figure 1. (A) Our retractor is easy to create, and low cost with reusability. (B) No long handle that may disturb procedures.
336
Letter to the Editor
ACKNOWLEDGMENTS
The authors thank Dr. Kenjiro Hasegawa for providing a valuable insight that led us to establish this retractor. Accordingly, we would like to call the retractor a “Hasegawa retractor.”
REFERENCES 1. Yamamoto T, Narushima M, Yoshimatsu H, Seki Y, Yamamoto N, Oka A, Hara H, Koshima I. Minimally invasive lymphatic supermicrosurgery (MILS): Indocyanine green lymphography-guided simultaneous multi-site lymphaticovenular anastomoses via millimeter skin incisions. Ann Plast Surg 2012;72:67–70.
Microsurgery DOI 10.1002/micr
2. Yamamoto T, Yoshimatsu H, Narushima M, Seki Y, Yamamoto N, Shim TW, Koshima I. A modified side-to-end lymphaticovenular anastomosis. Microsurgery 2013;33:130–133. 3. Yamamoto T, Narushima M, Doi K, Oshima A, Ogata F, Mihara M, Koshima I, Mundinger GS. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: The generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconst Surg 2011;127:1979– 1986. 4. Yamamoto T, Yamamoto N, Azuma S, Yoshimatsu H, Seki Y, Narushima M, Koshima I. Near-infrared illumination systemintegrated microscope for supermicrosurgical lymphaticovenular anastomosis. Microsurgery 2014;34:23–27. 5. Yamamoto T, Yamamoto N, Numahata T, Yokoyama A, Tashiro K, Yoshimatsu H, Narushima M, Koshima I. Navigation lymphatic supermicrosurgery for the treatment of cancer-related peripheral lymphedema. Vasc Endovasc Surg 2014;48:139–143.
