Open Access
CC BY 4.0 · Arch Plast Surg 2024; 51(06): 592-596
DOI: 10.1055/a-2375-8153
Communication

Lymphatic Mapping with Multi-Lymphosome Indocyanine Green Lymphography in Legs with Lymphedema

Hisako Hara 
1   Department of Lymphatic and Reconstructive Surgery, JR Tokyo General Hospital, Tokyo, Japan
,
Makoto Mihara 
2   Department of Lymphatic Surgery, Lymphedema Clinic, Tokyo, Japan
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Funding None.
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Abstract

It is observed that the locations of the most functional lymphatic vessels in the lymphedematous limbs can differ significantly from those in healthy limbs. The aim of this study was to elucidate the lymphatic map of lymphedematous limbs. We retrospectively analyzed 59 patients (118 limbs) with lower limb lymphedema. Fifty-five were women and four were men. The mean age and duration of lymphedema was 62.4 and 7.7 years, respectively. For the lateral thigh lymphosome, we injected indocyanine green (ICG) at the lateral knee and measured the distance (Dt) between the anterior superior iliac spine (ASIS) and the point where the lymphatic vessels crossed the reference line (the line connecting the ASIS and the patellar center). For the lateral calf lymphosome, we injected ICG at the lateral ankle and measured the distance (Dc) between the inferior patellar border and the point where the lymphatic vessels crossed the reference line (the anterior border of the tibia). In the lateral thigh, the mean Dt was 30.4 ± 0.6 cm (range, 0–41 cm) and the distribution peaked at approximately 30 cm from the ASIS. In the calf, the mean Dc was 13.1 ± 0.9 cm (range, −11 to 32 cm). The distribution of lymphatic vessel locations was highly variable. We could establish the lymphatic map in the lymphedematous legs. The distribution of lymphatic vessels in the thigh and lower legs had one and two peaks, respectively.

Keywords

lymphedema - lymphosome - ICG - lymphatic mapping - indocyanine green

Authors' Contributions

H.H. and M.M. substantially contributed to the study conceptualization, data analysis, interpretation, and manuscript drafting. Both authors critically reviewed and revised the manuscript draft and approved the final version for submission.


Ethical Approval

This study was approved by the JR Tokyo General Hospital Ethical Committee (approval number: 30-8).


Patient Consent

All patients were informed about the advantages and disadvantages of ICG lymphography and provided written consent.


Supplementary Material



Publication History

Received: 03 April 2024

Accepted: 27 July 2024

Accepted Manuscript online:
30 July 2024

Article published online:
17 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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