Taylor Lab ~ Current Projects

Dr Wei-Ren Pan M.D. – Senior Research Fellow

Dr Pan is continuing the Study of he Lymphatic Territories of the Head and Neck. This work is revealing unusual ampullae and nodes along the lymphatic pathways, bypass routes and previously unrecognised lymphatic to vein connections in the neck. Our refined technique facilitates successful injections into minute vessels less that 0.1mm.

CLINICAL APPLICATIONS

This study confirms the virtually unpredictable nature of the superficial lymphatic drainage of the head and neck making sentinel node biopsy in this area difficult. We have also shown a lack of symmetry between the left and right side of the head with consequences for surgeons treating melanomas.

Legend. X-rays showing unpredictable nature of the superficial lymphatic drainage of the head neck even each side of the same head.

Dr Hiroo Suami Ph.D, M.D. – Senior Research Fellow

Dr Suami has completed a lymphatic study on the superficial tissues of the upper limb and will continue with work on the upper torso and lower limbs. Results of the upper limb studies have revealed that the superficial lymphatic vessels course within the subcutaneous fat in close proximity to the main subcutaneous veins. Most lymph vessels on the front of the limb were seen to flow into one main lymph node in the axillary region, however, some of the lymph vessels ran along the posterior forearm, bypassing the main node to reach other smaller nodes. He has also had the rare opportunity to investigate the lymphatic system of both upper limbs harvested from a cadaver post unilateral mastectomy and axillary gland clearance. In the normal left arm there was no communication seen between the superficial and deep lymphatics except in the epitrochlear (elbow) region. However, the lymphatic pathways of the right arm on the mastectomy side showed significant differences: obliteration of superficial lymph vessels; dermal back flow; unusual communication between the superficial and deep lymphatics and interval lymph node enlargement. See Figure. These changes seem to facilitate lymph drainage after sporadic blockage of the lymph tract seen especially in the proximal limb.

CLINICAL APPLICATIONS

This study provides further information about the cause of lymphoedema and recurrence of malignant skin tumour after primary operation. It emphasises the importance of vigilant and vigorous treatment of any infection of the involved limb to prevent further destruction of lymphatic vessels and the precipitation of incapacitating lymphoedema (swelling) of the limb.

Tracings of lymphatics of both upper limbs from the mastectomy specimen with regard to the depth of each vessel. The lead oxide back flow from the collecting lymphatic channels to the precollectors (orange) can only be seen in he abnormal right upper limb. Note in the abnormal limb that the lymphatic flow has been diverted into the deep system above the elbow, that interval nodes are prominent and that some nodes still exist in the axilla.

Dr Warren Rozen- PhD student

Dr Rozen has completed the Postgraduate Diploma of Surgical Anatomy with The Royal Australasian College of Surgeons and The University of Melbourne in September 2005 and passed his Basic Surgical Training Examinations, Royal Australasian College of Surgeons in February 2006.      

His research is focused on breast reconstruction flaps after mastectomy. Breast cancer is the most common cause of cancer-related death in women. After mastectomy for breast cancer, breast reconstructive options include the TRAM (Trans Rectus Abdominis Myocutaneous) flap, the most common tissue flap used today. The (TRAM) flap involves microsurgery of fine branches of blood vessels supplying muscle and skin used in the tissue flap. With the anatomy of these blood vessels not adequately established, the operative technique involved is still evolving and still significant complications of the surgery occur.  It is hoped that this study will directly improve the operative technique for breast reconstruction.

The study will involve dissection of abdominal specimens from human cadavers to analyse the course of blood vessels supplying the abdominal wall. Both descriptions and measurements of vessels will be taken.  Blood vessels supplying the abdomen will be injected with lead to allow X-rays to be taken. These vessels will be analysed and compared to the dissected specimens. The tissue will then be cross-sectioned and reX-rayed, allowing 3-dimensional views to be obtained (See figure opposite).

3-Dimensional Cat Scan Angiograms of cadaveric specimens will also be taken thereby revealing the 3-dimensional images of blood vessels. Also, patients undergoing TRAM flap breast reconstructions through the Department of Plastic Surgery at the Royal Melbourne Hospital will undergo Cat Scan Angiograms. These scans will be compared to cadaveric scans, allowing the dissection and angiography of cadaveric specimens to be correlated to the anatomy of patients during their operations (Ethics HREC Project No: 2006.038).

CLINICAL APPLICATIONS

This pilot work will contribute directly to an improved understanding and selection of appropriate blood vessels used during TRAM flap operations and will allow surgeons to operate more efficiently and with fewer complications.

Legend: X-ray of two rotated periumbilical sections of the anterior abdominal wall and the perforators highlighted to demonstrate the significant transverse course through the rectus abdominis muscle, from their entry points (single arrow head) into the rectus abdominis muscle to their points of exit from the muscle (double arrow head).

AMS PROJECT

Tony Chen- AMS student. Blood supply of the Achilles Tendon

Tony Chen is a fourth year medicine student at the University of Melbourne.  Currently he is doing a research project with the The Jack Brockhoff Reconstructive Plastic Surgery Research Unit  The project will attempt to expand on previous studies, and provide greater detail on both the intrinsic and extrinsic blood supply of the Achilles Tendon.  This study will hopefully provide surgeons with accurate anatomical basis for choosing the type of Achilles Tendon surgery.  It may also provide some clue to the pathological basis of the location of Achilles Tendon rupture and Achilles Tendonitis.  He will be completing his research in June of 2007.

Legend: Tony Chen indicating the blood vessels to the Achilles tendon in one of his studies.