title: The use of a microscope with near-infrared imaging function in indocyanine green lymphography and lymphaticovenous anastomosis.
abstract: BACKGROUND
  Indocyanine green (ICG) lymphography has become an important investigation in lymphaticovenous anastomosis (LVA). Near-infrared (NIR) imaging systems are available in the market for the production of ICG lymphography. These machines, however, may be difficult to obtain owing to their costs. In our institute, these NIR imaging devices are not available. Alternatively, microscopy with NIR imaging function was used for LVA. The experiences of the production of ICG lymphography with an NIR microscope are described.
  
  
  METHODS
  For the production of preoperative ICG lymphography, ICG solution was injected subdermally to the web spaces of the lymphoedema limb. The NIR mode of the microscope was used for the lymphatic mapping. Black and white images and videos of the ICG lymphography were then produced. Intra-operatively, the NIR function was used for the localisation of lymphatic vessels and confirmation of the patency of the LVA.
  
  
  RESULTS
  Between February 2013 and May 2013, 24 ICG lymphographies were performed in 20 female patients as a preoperative investigation for LVA. All four ICG lymphography patterns (linear, splash, stardust and diffuse patterns) were demonstrated.
  
  
  CONCLUSIONS
  In institutes where NIR imaging devices are not available, we believe that a microscope with an NIR imaging function is a reasonable alternative for the production of ICG lymphography.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China. Electronic address: lawrencehlliu@gmail.com.
authors.forename: Hin-Lun
authors.initials: HL
authors.lastname: Liu
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China.
authors.forename: Suet-Ying
authors.initials: SY
authors.lastname: Pang
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam, Hong Kong, China.
authors.forename: Yu-Wai
authors.initials: YW
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D004396:Coloring Agents; D005260:Female; D005453:Fluorescence; D006801:Humans; D007208:Indocyanine Green; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000601:surgery*; D008220:Lymphography / Q000295:instrumentation*; D008853:Microscopy / Q000295:instrumentation*; D008875:Middle Aged; D011300:Preoperative Care / Q000295:instrumentation*; D014680:Veins / Q000601:surgery*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Fluorescence; ICG; Indocyanine green; LVA; Lymphatic mapping; Lymphaticovenous anastomosis; Lymphoedema; Lymphography; Near-infrared imaging