title: Indocyanine Green Lymphographic Evidence of Surgical Efficacy Following Microsurgical and Supermicrosurgical Lymphedema Reconstructions.
abstract: BackgroundMicrosurgical vascularized lymph node transfer (VLNT) and supermicrosurgical lymphaticovenular anastomosis (LVA) are increasingly performed to treat lymphedema. The surgical outcome is commonly assessed by volume-based measurement (VBM), a method that is not consistently reliable. We describe indocyanine green (ICG) lymphography as an alternative postoperative tracking modality after lymphatic reconstruction with VLNT and LVA.MethodsVLNT and LVA were performed in patients with therapy-refractory lymphedema. Patients were evaluated qualitatively by clinical assessment, quantitatively with VBM, and lymphographically using ICG lymphography. The evaluation was performed preoperatively, and at 3, 6, and 12-month postoperatively.ResultsOverall, 21 patients underwent lymphatic reconstruction with either VLNT or LVA. All reported prompt and durable relief of symptoms during the study period. All experienced disease regression based on the Campisi criteria. Out of the 21 patients, 20 (95%) demonstrated lymphographic down staging of disease severity. Out of the 21 patients, 3 (14%) developed a paradoxical increase in limb volume based on VBM despite clinical improvement.ConclusionsICG lymphography correlated highly with patient self-assessment and clinical examination, and is an effective postoperative tracking modality after lymphatic reconstruction.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Wei F
authors.initials: WF
authors.lastname: Chen
authors.affiliation: Division of Breast Surgery, Department of Surgery, The Second Hospital of Dalian Medical University, Dalian, China.
authors.forename: Haidong
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-Ku, Tokyo, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-Ku, Tokyo, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Hara
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
authors.forename: Johnson
authors.initials: J
authors.lastname: Ding
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D004396:Coloring Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000627:therapeutic use*; D042601:Lymphatic Vessels / Q000473:pathology / Q000601:surgery*; D008209:Lymphedema / Q000503:physiopathology / Q000601:surgery*; D008220:Lymphography; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green