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CC BY-NC 4.0 · Arch Plast Surg 2022; 49(01): 99-107
DOI: 10.5999/aps.2021.01235
Extremity/Lymphedema
Original Article

Three-dimensional analysis of dermal backflow in cancer-related lymphedema using photoacoustic lymphangiography

Anna Oh 
Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
,
Hiroki Kajita 
Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
,
Nobuaki Imanishi 
Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
,
Hisashi Sakuma 
Department of Plastic and Reconstructive Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
,
Yoshifumi Takatsume 
Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
,
Keisuke Okabe 
Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
,
Sadakazu Aiso 
Department of Anatomy, Keio University School of Medicine, Tokyo, Japan
,
Kazuo Kishi 
Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, Tokyo, Japan
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Background Dermal backflow (DBF), which refers to lymphatic reflux due to lymphatic valve insufficiency, is a diagnostic finding in lymphedema. However, the three-dimensional structure of DBF remains unknown. Photoacoustic lymphangiography (PAL) is a new technique that enables the visualization of the distribution of light-absorbing molecules, such as hemoglobin or indocyanine green (ICG), and can provide three-dimensional images of superficial lymphatic vessels and the venous system. This study reports the use of PAL to visualize DBF structures in the extremities of patients with lymphedema after cancer surgery.

Methods Patients with a clinical or lymphographic diagnosis of lymphedema who previously underwent surgery for cancer at one of two participating hospitals were included in this study. PAL was performed using the PAI-05 system. ICG was administered subcutaneously in the affected hand or foot, and ICG fluorescence lymphography was performed using a nearinfrared camera system prior to PAL.

Results Between April 2018 and January 2019, 21 patients were enrolled and examined using PAL. The DBF was composed of dense, interconnecting, three-dimensional lymphatic vessels. It was classified into three patterns according to the composition of the lymphatic vessels: a linear structure of lymphatic collectors (pattern 1), a network of lymphatic capillaries and lymphatic collectors in an underlying layer (pattern 2), and lymphatic capillaries and precollectors with no lymphatic collectors (pattern 3).

Conclusions PAL showed the structure of DBF more precisely than ICG fluorescence lymphography. The use of PAL to visualize DBF assists in understanding the pathophysiology and assessing the severity of cancer-related lymphedema.

Keywords

Lymphedema - Lymphography - Superficial lymphatic system

This research was funded by the ImPACT Program of Council for Science, Technology and Innovation (Cabinet Office, Government of Japan).




Publication History

Received: 02 July 2021

Accepted: 30 September 2021

Article published online:
02 June 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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