Lymphaticovenous anastomosis map established with lymphatic ultrasound and multi-lymphosome indocyanine green lymphography

Abstract

BackgroundAlthough the usefulness of lymphaticovenous anasotmosis (LVA) for lymphedema has been reported, it is difficult to determine where to perform LVA, especially for inexperienced surgeons. This study aimed to establish a map of the LVA site. MethodA total of 105 limbs of 64 patients who underwent lower limb LVA were retrospectively reviewed. Multi-lymphosome indocyanine green (ICG) lymphography (35 patients) and lymphatic ultrasound (all patients) were performed preoperatively and incision site was determined where dilated lymph vessels and appropriate veins were located in close proximity. The location of the LVA was identified using a postoperative photograph. Additionally, the degree of lymphatic degeneration at the LVA site was recorded based on the normal, ectasis, contraction, and sclerosis type (NECST) classification. ResultA total of 206 skin incisions were analyzed. Among them, 161 (75.9%) were medial and 45 (21.2%) were lateral. Of the 85 sites performed on the calf, 52 (61.2%) were medial and 33 (38.8%) were lateral. Of the 117 sites on the thigh, 106 (90.6%) were medial and 11 (9.4%) were lateral. As the severity of lymphedema progressed, the probability of performing LVA on the lateral calf increased. Of the 202 locations where LVA was performed on the thigh and lower leg, ectasis type was found in 164 sites (81.2%). ConclusionWe established an LVA map in the legs based on multi-lymphosome ICG lymphography and lymphatic ultrasound. With LVA map, surgeons could more easily predict the location of lymph vessels, thereby improving the success rate of LVA.