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J Reconstr Microsurg 2016; 32(09): 688-698
DOI: 10.1055/s-0036-1586254
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Indocyanine Green Lymphographic Evidence of Surgical Efficacy Following Microsurgical and Supermicrosurgical Lymphedema Reconstructions

Wei F. Chen
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Haidong Zhao
2   Division of Breast Surgery, Department of Surgery, The Second Hospital of Dalian Medical University, Dalian, China
,
Takumi Yamamoto
3   Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-Ku, Tokyo, Japan
,
Hisako Hara
3   Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-Ku, Tokyo, Japan
,
Johnson Ding
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
› Institutsangaben
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Publikationsverlauf

29. März 2016

07. Juni 2016

Publikationsdatum:
03. August 2016 (online)

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Abstract

Background Microsurgical 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.

Methods VLNT 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.

Results Overall, 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.

Conclusions ICG lymphography correlated highly with patient self-assessment and clinical examination, and is an effective postoperative tracking modality after lymphatic reconstruction.

Keywords

supermicrosurgery - lymphaticovenular anastomosis - LVA - lymphedema surgery - lymph node transfer - indocyanine green lymphography - lymphedema measurement

Statement of Authorship

Each person listed as an author has participated in the study to a significant extent.


 

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