J Reconstr Microsurg 2016; 32(01): 072-079
DOI: 10.1055/s-0035-1564608
Invited Review
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Indocyanine Green Lymphography Findings in Limb Lymphedema

Mitsunaga Narushima
1   Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
,
Takumi Yamamoto
1   Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
,
Fusa Ogata
2   Department of Cardiovascular Medicine, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
,
Hidehiko Yoshimatsu
1   Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
,
Makoto Mihara
1   Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
,
Isao Koshima
1   Department of Plastic and Reconstructive Surgery, Tokyo University School of Medicine, Bunkyo-ku, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

10 August 2015

12 August 2015

Publication Date:
30 September 2015 (online)

Abstract

Background and Methods Indocyanine green (ICG) lymphography is one of several methods of lymphography to detect lymphatic channels and evaluate patients clinically with limb lymphedema. ICG imaging is made possible by the use of a near-infrared camera device. The fluorescence images were digitalized for real-time display.

Results ICG lymphography findings are largely classifiable into two patterns: normal linear pattern and abnormal dermal backflow (DB) pattern. ICG lymphography pattern changes from the normal linear pattern to abnormal DB patterns in obstructive peripheral lymphedema; with progression of lymphedema, DB patterns change from splash pattern, to stardust pattern, and finally to diffuse pattern. We classify ICG lymphography progression into 0 to V stages for the upper extremity, the lower extremity and into 0 to IV stages for the genital area.

Conclusion In DB stage II, most patients are symptomatic; thus, aggressive treatments, such as lymphaticovenular anastomosis, are indicated. In DB stages III to V, lymphaticovenular anastomosis is recommended because most patients are refractory to conservative therapies.

 
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