Open Access
CC BY 4.0 · Arch Plast Surg 2025; 52(03): 178-184
DOI: 10.1055/a-2511-8588
Extremity/Lymphedema
Original Article

LVA for Advanced Unilateral Lower Extremity Lymphedema: Impact of ICG Lymphography of Normal Side in Improving the Lymphatic Detection Rate and Operative Time

Usama Abdelfattah 
1   Department of Plastic and Reconstructive Surgery, Al-Azhar University, Cairo, Egypt
2   Department of Plastic and Reconstructive Surgery, El Nile Insurance Hospital, Cairo, Egypt
,
Tarek Elbanoby 
1   Department of Plastic and Reconstructive Surgery, Al-Azhar University, Cairo, Egypt
,
Mona Omarah 
2   Department of Plastic and Reconstructive Surgery, El Nile Insurance Hospital, Cairo, Egypt
,
Saber M. Abdelmaksoud 
3   Department of Plastic and Reconstructive Surgery, Port Said University, Port Said, Egypt
,
Eatmad Allam 
4   Department of Physiotherapy, Al-Azhar University, Cairo, Egypt
,
Serag Monir 
1   Department of Plastic and Reconstructive Surgery, Al-Azhar University, Cairo, Egypt
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Abstract

Background Indocyanine green (ICG) lymphography has limited use in the detection of functioning lymphatics in advanced lymphedema. This study presents the use of normal-side ICG lymphography to navigate the potential sites of functional lymphatics and reports its impact on the lymphatic detection rate and operative time.

Methods This was a retrospective study of unilateral lower extremity late-stage II or III lymphedema patients who underwent lymphaticovenous anastomosis (LVA) between February 2018 and June 2022.

Markings for possible lymphatic vessels were made on the affected side solely in the early group (2018–2019) and on both the affected and normal side in the late group (2020–2022) using ICG lymphography.

Results Between 2018 and 2022, 86 patients had complete data for analysis. Dermal backflow stage III was present in 5 limbs (5.81%), stage IV in 40 limbs (46.51%), and stage V in 41 limbs (47.67%). The late group had a higher mean lymphatic detection rate, which was statistically significant in the proximal leg incision site (2.05 ± 0.91 vs. 0.74 ± 0.82; p = 0.041). There was a significant tendency toward lower total LVA operative time per limb in the late group, which was led by the normal side mapping, with a mean operative time of 158 ± 14.88 minutes compared with 199 ± 12.45 minutes in the early group (p = 0.035).

Conclusion Mirroring the affected limb by utilizing the normal-side ICG lymphography in guiding the incision sites for LVA could improve the lymphatic detection rate, minimize the number of incisions, and shorten the operative time.

Keywords

LVA - advanced lymphedema - lower extremity

Authors' Contributions

T.E.: draft revision.

M.O.: data collection and draft writing.

S.M.A.: data analysis and interpretation.

S.M.: preparing the manuscript for submission.

U.A.: data analysis, and manuscript revision and interpretation of data.

E.A.: draft writing and data collection.


Ethical Approval

Approval from the Institutional Review Board and ethical committee at Al-Azhar University (Azhar.edu2022-1181).


Patient Consent

Written informed consent was obtained from all individuals included in this study.




Publication History

Received: 24 July 2023

Accepted: 30 January 2024

Accepted Manuscript online:
09 January 2025

Article published online:
01 April 2025

© 2025. 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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