title: Scarless lymphatic venous anastomosis for latent and early-stage lymphoedema using indocyanine green lymphography and non-invasive instruments for visualising subcutaneous vein.
abstract: BACKGROUND
  Lymphoedema can be treated conservatively or surgically. Early treatment is important, but the surgical indication and the effect of surgery on pain in lymphoedema-affected limbs have not been described. The objective of this study was to examine the effect of low-invasive scarless lymphatic venous anastomosis (LVA) for early or latent lymphoedema.
  
  
  METHODS
  LVA was performed in six patients (eight legs) with leg lymphoedema between April 2010 and March 2011. Lymphoedema was stage 0 (defined as subclinical) in three patients (five legs) and stage 1 in three patients (three legs). Subjective symptoms, circumference of the affected leg and a lymphoscintigram were evaluated before and 6 months after surgery. Preoperatively, subcutaneous lymph vessels and veins were identified non-invasively using ICG lymphoscintigraphy and non-invasive instruments for visualising subcutaneous vein, AccuVein system, through the skin. These vessels and veins were secured with vessel loops passed underneath and side-to-side anastomosed under a surgical microscope.
  
  
  RESULTS
  Subjective symptoms improved after surgery in all patients. The leg circumference improved in stage 1 cases, which all had an increased circumference before surgery. Lymph retention was observed on preoperative lymphoscintigraphy in all six patients and was improved after surgery in all cases.
  
  
  CONCLUSIONS
  Scarless LVA performed through a small incision improves abnormal lymph circulation and subjective symptoms in cases of early lymphoedema, in which the limb circumference has just started to increase, and latent lymphoedema, in which the circumference has not increased, but abnormal findings on lymphoscintigraphy or subjective symptoms are present.
authors: Department of Plastic and Reconstructive Surgery, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan. mihara@keiseigeka.name
authors: Makoto
authors: M
authors: Mihara
authors: Hisako
authors: H
authors: Hara
authors: Kazuki
authors: K
authors: Kikuchi
authors: Takumi
authors: T
authors: Yamamoto
authors: Takuya
authors: T
authors: Iida
authors: Mitsunaga
authors: M
authors: Narushima
authors: Jun
authors: J
authors: Araki
authors: Noriyuki
authors: N
authors: Murai
authors: Kito
authors: K
authors: Mitsui
authors: Paolo
authors: P
authors: Gennaro
authors: Guido
authors: G
authors: Gabriele
authors: Isao
authors: I
authors: Koshima
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007866:Leg; D008209:Lymphedema / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008220:Lymphography; D061305:Lymphoscintigraphy; D008875:Middle Aged; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000150:complications
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green