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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
› Author Affiliations
Further Information

Publication History

29 March 2016

07 June 2016

Publication Date:
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.


 

  • References

  • 1 Yamamoto T, Matsuda N, Doi K , et al. The earliest finding of indocyanine green lymphography in asymptomatic limbs of lower extremity lymphedema patients secondary to cancer treatment: the modified dermal backflow stage and concept of subclinical lymphedema. Plast Reconstr Surg 2011; 128 (4) 314e-321e
    CrossrefPubMedGoogle Scholar
  • 2 Masia J, Olivares L, Koshima I , et al. Barcelona consensus on supermicrosurgery. J Reconstr Microsurg 2014; 30 (1) 53-58
    PubMedGoogle Scholar
  • 3 Lin C-H, Ali R, Chen S-C , et al. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Plast Reconstr Surg 2009; 123 (4) 1265-1275
    CrossrefPubMedGoogle Scholar
  • 4 Cheng M-H, Chen S-C, Henry SL, Tan B-K, Lin MC, Huang J-J. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes. Plast Reconstr Surg 2013; 131 (6) 1286-1298
    CrossrefPubMedGoogle Scholar
  • 5 Sapountzis S, Singhal D, Rashid A, Ciudad P, Meo D, Chen H-C. Lymph node flap based on the right transverse cervical artery as a donor site for lymph node transfer. Ann Plast Surg 2014; 73 (4) 398-401
    CrossrefPubMedGoogle Scholar
  • 6 Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg 2013; 132 (5) 1305-1314
    CrossrefPubMedGoogle Scholar
  • 7 Yamamoto T, Narushima M, Yoshimatsu H , et al. Minimally invasive lymphatic supermicrosurgery (MILS): indocyanine green lymphography-guided simultaneous multisite lymphaticovenular anastomoses via millimeter skin incisions. Ann Plast Surg 2014; 72 (1) 67-70
    CrossrefPubMedGoogle Scholar
  • 8 Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000; 16 (6) 437-442
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Campisi C, Boccardo F, Zilli A, Macciò A, Napoli F. Long-term results after lymphatic-venous anastomoses for the treatment of obstructive lymphedema. Microsurgery 2001; 21 (4) 135-139
    CrossrefPubMedGoogle Scholar
  • 10 Chang DW. Lymphaticovenular bypass for lymphedema management in breast cancer patients: a prospective study. Plast Reconstr Surg 2010; 126 (3) 752-758
    CrossrefPubMedGoogle Scholar
  • 11 Yamamoto T, Matsuda N, Todokoro T , et al. Lower extremity lymphedema index: a simple method for severity evaluation of lower extremity lymphedema. Ann Plast Surg 2011; 67 (6) 637-640
    CrossrefPubMedGoogle Scholar
  • 12 Yamamoto T, Yamamoto N, Hara H, Mihara M, Narushima M, Koshima I. Upper extremity lymphedema index: a simple method for severity evaluation of upper extremity lymphedema. Ann Plast Surg 2013; 70 (1) 47-49
    CrossrefPubMedGoogle Scholar
  • 13 Granzow JW, Soderberg JM, Kaji AH, Dauphine C. An effective system of surgical treatment of lymphedema. Ann Surg Oncol 2014; 21 (4) 1189-1194
    CrossrefPubMedGoogle Scholar
  • 14 Damstra RJ, Voesten HGJ, van Schelven WD, van der Lei B. Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Res Treat 2009; 113 (2) 199-206
    CrossrefPubMedGoogle Scholar
  • 15 Yamamoto T, Yamamoto N, Doi K , et al. Indocyanine green-enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011; 128 (4) 941-947
    CrossrefPubMedGoogle Scholar
  • 16 Yamamoto T, Narushima M, Doi K , et al. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011; 127 (5) 1979-1986
    CrossrefPubMedGoogle Scholar
  • 17 Yamamoto T, Narushima M, Yoshimatsu H , et al. Indocyanine green velocity: lymph transportation capacity deterioration with progression of lymphedema. Ann Plast Surg 2013; 71 (5) 591-594
    CrossrefPubMedGoogle Scholar
  • 18 Yamamoto T, Yoshimatsu H, Narushima M, Yamamoto N, Hayashi A, Koshima I. Indocyanine Green Lymphography Findings in Primary Leg Lymphedema. Eur J Vasc Endovasc Surg 2015; 49 (1) 95-102
    CrossrefPubMedGoogle Scholar
  • 19 Yamamoto T, Narushima M, Yoshimatsu H , et al. Dynamic Indocyanine Green (ICG) lymphography for breast cancer-related arm lymphedema. Ann Plast Surg 2014; 73 (6) 706-709
    CrossrefPubMedGoogle Scholar
  • 20 Yamamoto T, Yoshimatsu H, Narushima M , et al. Sequential anastomosis for lymphatic supermicrosurgery: multiple lymphaticovenular anastomoses on 1 venule. Ann Plast Surg 2014; 73 (1) 46-49
    CrossrefPubMedGoogle Scholar
  • 21 Chen WF, Yamamoto T, Fisher M, Liao J, Carr J. The “Octopus” Lymphaticovenular Anastomosis: Evolving Beyond the Standard Supermicrosurgical Technique. J Reconstr Microsurg 2015; 31 (6) 450-457
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Brorson H, Höijer P. Standardised measurements used to order compression garments can be used to calculate arm volumes to evaluate lymphoedema treatment. J Plast Surg Hand Surg 2012; 46 (6) 410-415
    CrossrefPubMedGoogle Scholar
  • 23 Gharb BB, Rampazzo A, Spanio di Spilimbergo S, Xu E-S, Chung K-P, Chen H-C. Vascularized lymph node transfer based on the hilar perforators improves the outcome in upper limb lymphedema. Ann Plast Surg 2011; 67 (6) 589-593
    CrossrefPubMedGoogle Scholar
  • 24 Armer JM. The problem of post-breast cancer lymphedema: impact and measurement issues. Cancer Invest 2005; 23 (1) 76-83
    CrossrefPubMedGoogle Scholar
  • 25 Tierney S, Aslam M, Rennie K, Grace P. Infrared optoelectronic volumetry, the ideal way to measure limb volume. Eur J Vasc Endovasc Surg 1996; 12 (4) 412-417
    CrossrefPubMedGoogle Scholar
  • 26 Narushima M, Yamamoto T, Ogata F, Yoshimatsu H, Mihara M, Koshima I. Indocyanine Green Lymphography Findings in Limb Lymphedema. J Reconstr Microsurg 2016; 32 (1) 72-79
    PubMedGoogle Scholar
  • 27 Patel KM, Lin C-Y, Cheng M-H. From theory to evidence: long-term evaluation of the mechanism of action and flap integration of distal vascularized lymph node transfers. J Reconstr Microsurg 2015; 31 (1) 26-30
    PubMedGoogle Scholar
  • 28 Keeley V, Crooks S, Locke J, Veigas D. A quality of life measure for limb lymphoedema (LYMQOL). Journal of Lymphoedema. 2010; 5 (1) 26-37
    PubMedGoogle Scholar
  • 29 Cemal Y, Jewell S, Albornoz CR, Pusic A, Mehrara BJ. Systematic review of quality of life and patient reported outcomes in patients with oncologic related lower extremity lymphedema. Lymphat Res Biol 2013; 11 (1) 14-19
    CrossrefPubMedGoogle Scholar
  • 30 Penha TR, Botter B, Heuts EM, Voogd AC, von Meyenfeldt MF, van der Hulst RR. Quality of Life in Patients with Breast Cancer-Related Lymphedema and Reconstructive Breast Surgery. J Reconstr Microsurg 2016; 32 (6) 484-490
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Becker C, Vasile JV, Levine JL , et al. Microlymphatic surgery for the treatment of iatrogenic lymphedema. Clin Plast Surg 2012; 39 (4) 385-398
    CrossrefPubMedGoogle Scholar