Surgery

The patient was taken to the operating room 24 hours after lymphoscintigraphy. One milliliter of patent blue dye was administered around the biopsy site on the right buttock. The gamma detection probe confirmed that the sentinel node was situated exactly underneath the skin mark placed by the nuclear medicine physician. A 4-cm incision was made over the skin mark, and three lymphatic vessels were identified underneath Scarpa's fascia. The vessels were observed converging on one blue radioactive lymph node. Two efferent blue ducts emerged at the opposite end of the sentinel node and led to a more caudally located second-tier

Second Tier Nodes

Figure 17 The dynamic images at 10 minutes after injection of the tracer show drainage to one sentinel node in the right groin inferior from Pouparfs ligament. The later images demonstrate two second-tier nodes higher up and one that is situated more caudally. The lateral view demonstrates that one of the second-tier nodes is situated in the deep inguinal area (arrow).

Figure 17 The dynamic images at 10 minutes after injection of the tracer show drainage to one sentinel node in the right groin inferior from Pouparfs ligament. The later images demonstrate two second-tier nodes higher up and one that is situated more caudally. The lateral view demonstrates that one of the second-tier nodes is situated in the deep inguinal area (arrow).

node that was blue and radioactive as well. The blue dye pattern thus showed that this latter node was indeed a second-tier node.

Both nodes were freed from the surrounding tissue. Lymph vessels and blood vessels to and from the nodes were ligated and divided, and the nodes were removed. Subsequently, another second-tier node was collected with the aid of the gamma-ray detection probe. A third second-tier node was not pursued when probe measurements indicated that it was situated above Poupart's ligament.

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