Role of ICG Lymphangiography in Genital Lymphedema

Correspondence: Kalai Selvan (E-mail: [e-mail])

Abstract

Background Genital lymphedema is a debilitating disease causing both physical discomfort and psychological distress. Conservative management is more difficult compared to extremity lymphedema, owing to the difficulties in using compression garments

Aims Study the pattern of ICG lymphangiography in genital lymphedema, as there is a paucity of literature on findings of ICG (indocyanine green) lymphangiography in patients with genital lymphedema.

Methodology Retrospective study to collect data of patients with genital lymphedema from January 2021 to August 2025. Indocyanine green was injected into the scrotum of males and the vulva in females, and a gentle massage was done for 5 minutes. We assessed the various patterns of superficial lymphatics on both sides by using a surgical microscope. Based on the drainage of lymphatics selection of the site of anastomosis was done.

Discussion We are hereby sharing our experience in treating Cases with genital lymphedema using ICG. For linear patterns, we performed lymphatico-venous anastomosis [LVA], and for diffuse patterns. Lymph node venous anastomosis (LNVA) was done.

Case Report

Case 1—Female patient with secondary lymphedema following hidradenitis suppurativa. The scarred skin over the mons pubis was excised, and a medial thigh flap was done as a lymph interpositional flap transfer [LIFT] procedure. On follow-up ICG, upon injecting dye into the vulva, transport of dye was seen across the flap.

Case 2—Patient had primary lymphedema of the bilateral lower limbs and scrotum with secondary infection as part of Noonan's syndrome. We did stage reconstructive procedures as well as debulking procedures. Case 3—Patient had scrotal lymphedema secondary to filarial infection. Lymphovenous anastomosis and lymph node venous anastomosis were done.

Conclusion The purpose of this report is to explain how the intraoperative ICG usage helped in making a decision on performing the procedure, e.g., making a guide on how to approach genital lymphedema. We noticed a significant reduction in the disease morbidity, improving patient well-being and quality of life.

Keywords: genital lymphedema, ICG lymphangiography, LVA, LNVA, surgical planning

Publikationsverlauf

Artikel online veröffentlicht:
10. November 2025