Application of indocyanine green lymphography combined with methylene blue staining in lymphaticovenular anastomosis of lower limb vessels: A prospective study

Abstract

Background Methylene blue (MB) is a conventional lymphatic tracer. We evaluated the application of indocyanine green (ICG) lymphography combined with MB staining in lower limb lymphaticovenular anastomosis (LVA). Methods A total of 49 patients with lower limb lymphedema were selected as the study subjects and divided into the research ( n = 27) and control groups ( n = 22). The patients were treated with LVA using ICG lymphography combined with MB staining and simple ICG lymphography as the positioning method, respectively. The number of lymphatic vessels anastomosed and the operating time were compared between the groups. Lower Extremity Lymphedema Index (LEL index) and Lymphoedema Functioning, Disability and Health Questionnaire for Lower Limb Lymphoedema (Lymph-ICF-LL) were used as prognostic indices; 6 months after LVA, both groups were evaluated for the symptomatic relief of lymphedema. Results The number of anastomotic lymphatic vessels in the study group was higher than that in the control group ( p < .05), and their procedural time was shorter than that in the control group. The two groups had no significant difference in lymphatic anastomosis time ( p > .05). The LEL index and Lymph-ICF-LL of the research and control groups at 6-month follow-up after LVA were lower than those before the operation ( p < .05). Conclusion The circumference of the affected limb is reduced after LVA in patients with lower extremity lymphedema with a favorable prognosis. ICG lymphography combined with MB staining has the advantages of real-time visualization and accurate localization.

Application of complete decongestive therapy after lymphaticovenular anastomosis of the lower limb combined with liposuction-A retrospective study research

“…Currently, the treatment methods for lymphedema include conservative treatment, lesion tissue resection, liposuction, lymphaticovenular anastomosis (LVA), and lymph node transplantation. 8–11 With the progress of microsurgery equipment and technology, super microsurgery has been used to perform LVA in clinical practice. Through the anastomosis of subcutaneous peripheral micro lymphatic vessels and their accompanying superficial veins, the stagnant lymph fluid is introduced into the venous system further to promote the lymphatic reflux of the affected limb.…”

Is immediate lymphatic reconstruction the future of lymphedema prevention?

“…First, we wonder if there are any differences among the surgeons in their rate of finding suitable veins and lymphatic channels intraoperatively and if they performed any tests on the lymphatic system to verify if they were functional before proceeding with the bypass. Additionally, we would like to know if they tested the anastomosis using any contrast agents before ending the procedure since it’s important to make sure that despite finding the vessels and connecting them, the anastomosis was patent ( 8 - 10 ).…”