Usefulness of Tapered Cutting Needles for Lymphaticovenular Anastomosis.

We report the usefulness of a tapered cutting needle, which has a polyhedral tip similar to that of a square needle and transitions to a round tip in the middle, for super-microsurgery. We have performed more than 500 lymphaticovenular anastomoses (LVAs) using tapered cutting needles. Therefore, we investigated the caliber of the anastomosed lymphatic vessels and veins, characteristics of the lymphatic vessels, the time required to perform the anastomosis, damage to the lymphatic vessels and veins during anastomosis, and patency of 30 recently performed consecutive anastomoses. The mean caliber of the anastomosed lymphatic vessels was 0.68 mm (range, 0.4-1.2 mm), and the mean caliber of the veins was 0.87 mm (range, 0.5-1.5 mm). Regarding the progression of fibrosis, 14 cases were classified as no degeneration, 13 cases were classified as mild degeneration, 2 cases were classified as moderate degeneration, and 1 case was classified as severe degeneration. The average time required to perform the anastomosis was 10.53 minutes (range, 8-13 minutes). No cases of lymphatic or venous injury or laceration occurred during the anastomosis procedure. After the anastomosis was created, intraoperative patency was observed in all patients. The tapered cutting needle is useful for LVAs because of its excellent thread-ability and protective properties for blood vessels. Furthermore, the tapered cutting needle is useful for short anastomoses, regardless of the diameter or condition of the lymphatic vessels. In the future, the tapered cutting needle is expected to become the needle of choice for LVAs.