Anaphylactic Reaction to Patent Blue Dye After Supermicrosurgical Lymphaticovenular Anastomosis for the Treatment of Secondary Lymphedema.

For decades, patent blue dye (PBV) has been utilized for sentinel lymph node biopsy and lymphatic mapping in breast cancer and melanoma staging and treatment. Fistulography and intraoperative display of lymphatic vessels for lymphaticovenular anastomosis (LVA) are frequent applications. Although its anaphylactic potential is well described, PBV is used routinely. We present the case of a 71-year-old female patient, who underwent LVA for the treatment of chronic secondary lymphedema and experienced a postoperative anaphylactic reaction including a blue-colored drug-induced maculopapular exanthema after PBV administration. This article aims to raise awareness of potential life-threatening allergic reactions and propose an alternative to PBV.

Delayed Partial Venous Insufficiency of Free Flap: To Intervene or Not?

Delayed venous congestion of a free flap poses a dilemma for clinicians, as the optimal management strategy is often uncertain. This case report presents a successful outcome achieved through a strategy of watchful waiting for a delayed presentation of a partially congested free flap. This approach enabled the avoidance of unnecessary surgical interventions and minimized potential complications associated with flap exploration. By adopting a watchful waiting strategy, clinicians can navigate the challenging decision-making process in cases of partial venous congestion of free flaps, optimizing patient outcomes.