Multi-area lymphaticovenous anastomosis with multi-lymphosome injection in indocyanine green lymphography: A prospective study.

Abstract

Detecting more number of functional lymphatic vessels is the essential point in lymphaticovenous anastomosis (LVA). The purpose of this prospective study was to elucidate the efficacy of multi-area injection in indocyanine green (ICG) lymphography in LVA. We injected ICG into the first web spaces of the feet or the second web space of the hands, subcutaneously. In multi-area injection group, we injected additional ICG in other areas. We determined the incision design of LVA on the line at about 5 cm distal to dermal backflow point. In control group, we determined the incision site based on the linear pattern in ICG lymphography and lymphoscintigraphic findings. We performed LVA, and evaluated the circumference change and the intraoperative condition of the collecting lymphatic vessels based on Normal, Ectasis, Contraction, and Sclerosis Type (NECST) classification. Sixty patients (115 limbs) in multi-injection group and 49 patients (81 limbs) in control group were included. We injected ICG into an average of 1.9 sites in multi-injection group. The average number of anastomoses per limb was 3.3 in both groups. The average circumference change was -1.83% in multi-injection group and -0.34% in control group (P = .021). The percentage of the Ectasis type lymphatic vessels was 59.0% in multi-injection group and 40.2% in control group (P = 3.30 × 10^-5 ). By injecting ICG into multiple sites in the affected limbs, we could detect a greater number of functional lymphatic vessels (Ectasis type) during LVA. This could lead to a better surgical result.