title: Successful treatment of early-stage lower extremity lymphedema with side-to-end lymphovenous anastomosis with indocyanine green lymphography assisted.
abstract: OBJECTIVE
  This study was to investigate intraoperative assessment of side-to-end lymphovenous anastomosis (LVA) with indocyanine green (ICG) and the correlation between its patency and surgical outcome.
  
  
  METHODS
  LVA was applied to five patients with early-stage lower extremity lymphedema. Side-to-end anastomosis and then end-to-end anastomosis were created as a second alternative. Immediately after the anastomosis, ICG was used to confirm its patency.
  
  
  RESULTS
  The mean number of anastomoses was 2.0 ± 0.7, and the types of anastomoses were primarily side-to-end and secondarily end-to-end. The mean reduction rate was 63.8 ± 20.2% after LVA at 10 ± 6.4 months of follow-up. In all cases, the affected extremities became soft immediately after surgery, and no cellulitis episodes were observed.
  
  
  CONCLUSIONS
  Side-to-end LVA can be an effective treatment for early-stage lower extremity lymphedema. ICG lymphodynamic assessment is useful not only in the preoperative identification of functional lymphatics but also in the intraoperative visualization of new drainage routes in LVA surgery. © 2015 Wiley Periodicals, Inc. Microsurgery 36:310-315, 2016.
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Department of Plastic and Reconstructive Surgery, Kyoto University, Kyoto, Japan.
authors.forename: Ran
authors.initials: R
authors.lastname: Ito
authors.affiliation: Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chieh-Tsai
authors.initials: CT
authors.lastname: Wu
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Miffy Chia-Yu
authors.initials: MC
authors.lastname: Lin
authors.affiliation: Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.|Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Ming-Huei
authors.initials: MH
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D005456:Fluorescent Dyes; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D007430:Intraoperative Care / Q000379:methods*; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D008209:Lymphedema / Q000601:surgery*; D008220:Lymphography; D008875:Middle Aged; D016896:Treatment Outcome; D014680:Veins / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D005456:Fluorescent Dyes; D007208:Indocyanine Green