title: Predictive lymphatic mapping: a method for mapping lymphatic channels in patients with advanced unilateral lymphedema using indocyanine green lymphography.
abstract: In severe lymphedema, indocyanine green lymphography cannot be used to map lymphatic channels before lymphaticovenular anastomosis (LVA) because linear lymphatics cannot be detected in a severely affected leg. Here, we describe a new method, which we refer to as predictive lymphatic mapping, to predict the location of lymphatics for anastomosis in unilateral lymphedema, thereby improving surgical accuracy and efficiency. The approach consists of marking anatomical landmarks and joining selected landmarks with fixed lines. The distance from these fixed lines to lymphatic channels mapped by indocyanine green lymphography in the unaffected leg is then measured, scaled up based on the difference in circumference between the legs, and transposed to the affected leg. To date, we have used this method in 5 cases of unilateral or asymmetric lymphedema of the lower extremities. In no cases have we failed to find a lymphatic channel suitable for LVA within a 2-cm incision. These results suggest that predictive lymphatic mapping is a useful additional tool for surgeons performing LVA under local anesthesia, which will help to improve the accuracy of incisions and the efficiency of surgery.
authors.affiliation: From the *Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan; †Department of Plastic and Reconstructive Surgery, Oxford University Hospitals, West Wing, John Radcliffe Hospital, Oxford, United Kingdom; ‡Division of Plastic and Reconstructive Surgery, Department of Surgery, Queen Mary Hospital, Hong Kong; and §Department of Vascular Surgery, Saiseikai Kawaguchi Hospital, Kawaguchi, Saitama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Mihara
authors.forename: Yukio
authors.initials: Y
authors.lastname: Seki
authors.forename: Hisako
authors.initials: H
authors.lastname: Hara
authors.forename: Takuya
authors.initials: T
authors.lastname: Iida
authors.forename: Aiko
authors.initials: A
authors.lastname: Oka
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.forename: Makiko
authors.initials: M
authors.lastname: Haragi
authors.forename: Dominic
authors.initials: D
authors.lastname: Furniss
authors.forename: Lawrence
authors.initials: L
authors.lastname: Hin-Lun
authors.forename: Kito
authors.initials: K
authors.lastname: Mitsui
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Murai
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000328:Adult; D000368:Aged; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D042601:Lymphatic Vessels / Q000473:pathology*; D008209:Lymphedema / Q000175:diagnosis* / Q000601:surgery*; D008875:Middle Aged
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green