Practical Lymphatic Ultrasound for Supermicrosurgical Lymphaticovenous Anastomosis: Preoperative Lymphatic Mapping Using Conventional High-Frequency Ultrasound.

Abstract

Ultrasound (US) has many advantages and is useful for mapping lymph vessels and veins for lymphovenous anastomosis (LVA) and improving their outcomes. However, it is operator-dependent and required some experience. Our aim was to describe how to perform preoperative mapping of LVA using high-frequency US (HFUS) in B mode. Experiences about preoperative planning of LVA surgeries in patients with upper and lower limb lymphedema using HFUS were the basis of our guide. In addition, data of women with secondary lower limb lymphedema who undergone LVA was analyzed. US examination was performed on the previous day of surgery for mapping lymph vessels and veins using a linear transducer of 18 MHz and B mode. A standardized method to perform step by step the preoperative planning of LVA using HFUS was described. A total of 349 incisions performed in 97 lower limbs were analyzed. The overall success rate for identifying lymph vessels was 99.7%. Mean diameters of lymph vessels and veins were 0.65 mm and 0.81 mm, respectively. Skin incision length was 1.97 cm (range, 1.2-3.8 cm). Surgical time for each LVA was 21.7 minutes (range, 13-47 min). There were a reduction of limb volume index (281.2 vs 267.6, P = 0.002) and an improvement in the quality of life of patients (48.3 vs 21.9, P < 0.001). A standardized method can be followed to effectively perform the preoperative mapping of LVA using HFUS to reduce the limb volume and improve the quality of life of patients with lymphedema.