Lymphatic Regeneration Visualized on Magnetic Resonance Imaging After Placement of Aligned Nanofibrillar Collagen Scaffolds for Treatment of Lymphedema.

Abstract

Lymphatic regeneration has been shown after placement of aligned nanofibrillar collagen scaffolds (BioBridge) in animal models and humans with multiple imaging modalities including indocyanine green lymphography, histology, and computed tomography. The aim of our study is to demonstrate new lymphatic regeneration visualized on magnetic resonance imaging (MRI) after aligned nanofibrillar collagen scaffold placement. We retrospectively studied patients with extremity lymphedema who underwent placement of BioBridge. Additionally, most of these patients had lymphaticovenous bypass, vascularized lymph node transfer, or liposuction. MR lymphangiogram was performed at least a year postoperatively. The postoperative MRI images demonstrate new lymphatic collectors in both upper and lower extremities where aligned nanofibrillar collagen scaffolds were implanted from sites of lymphaticovenous bypass or vascularized lymph node transfer in the distal limb to proximal lymph node basins in the groin or axilla. Additionally, new lymphatic collectors are visualized between left and right lymph node basins in the groin or supraclavicular region when aligned nanofibrillar collagen scaffolds were placed from the effected extremity to the contralateral lymph node basin. For these patients, lymphatic regeneration along with decrease in limb volume suggests that Aligned nanofibrillar collagen scaffold placement generates functional lymphatic collectors that improve lymphedema.