Abstract
Combining intraoperative ICG lymphography with NIR vein visualization can aid supermicrosurgeons in identifying lymphatic vessels and superficial venules to guide LVA incision placement. This guided approach significantly improves successful creation of LVAs when compared to the blind (anatomic) approach. In addition, the absence of linear ICG lymphographic patterns does not prevent formation of successful LVAs.
Highlights
Supermicrosurgical lymphaticovenular anastomosis (LVA) has become an accepted and effective treatment for lymphedema
The follow-up period ranged from five to nine months; no patients were lost to follow up. At their follow-up appointments, all patients reported a decrease in lymphedema-related symptoms that paralleled their improved findings on clinical exam, validated quality of life assessment, and indocyanine green (ICG) lymphography
A total of 99 LVAs were created through 80 incisions by senior author WFC
Summary
Supermicrosurgical lymphaticovenular anastomosis (LVA) has become an accepted and effective treatment for lymphedema. Surgeons performing these procedures, have been perplexed in determining where to place their incisions to maximize the number of LVAs constructed. We describe our guided approach to incision placement to increase the likelihood of creating a successful LVA at each incision. Conclusion: Use of a multimodality image guided approach significantly increases the probability of successful LVA creation at each incision as well as the total number of LVAs that are created within each incision. One of the difficulties the surgeons encounter while performing LVA is in determining where to place incisions to access veins and lymphatic vessels meeting these criteria
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