Intraoperative identification and definition of “functional” lymphatic collecting vessels for supermicrosurgical lymphatico-venous anastomosis in treating lymphedema patients

Johnson Chia Shen Yang, Shao Chun Wu, Min Hsien Chiang, Wei Che Lin, Ching Hua Hsieh*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

39 Scopus citations

Abstract

Background: For current lymphatico-venous anastomosis (LVA), the identification of “functional” lymphatic collecting vessels (LCVs) is mainly based on indocyanine green (ICG) lymphography. However, some of the non-ICG enhanced LCVs utilized for LVA were found to have visual lymphatic flow. Objectives: Should non-ICG enhanced, but flow-positive LCVs be considered functional as well?. Methods: A retrospective study with 56 consecutive lymphedema patients (8 male/48 female) received LVA. LCVs were observed after ICG injection, before/after LVAs were performed. ICG enhancement and lymphatic flow in the LCVs were recorded and grouped as: Group A: all LCVs ICG(+) and flow(+); Group B: all LCVs ICG(+) and some were flow(+); Group C: some ICG(+) and some flow(+) LCVs; Group D: all LCVs ICG(−)but all flow(+); and Group E: all LCVs were both ICG(−) and flow(−). Results: A total of 366 LCVs were identified, averaging 8.2 LVAs, 6.5 LCVs, and 4.7 veins per patient. A total of 33 LVAs were performed with 27 LCVs with no ICG enhancement from 7 patients (Group D). These patients were satisfied with their lymphedema improvements. Conclusion: Lymphatic flow-positive but non-ICG enhanced LCVs, should also be considered as functional, thereby maximizing the number of functional LCVs for LVA.

Original languageEnglish
Pages (from-to)994-1000
Number of pages7
JournalJournal of Surgical Oncology
Volume117
Issue number5
DOIs
StatePublished - 01 04 2018

Bibliographical note

Publisher Copyright:
© 2018 Wiley Periodicals, Inc.

Keywords

  • LVA
  • functional lymphatic vessel
  • lymphatico-venous anastomosis
  • lymphedema
  • supermicrosurgery

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