Upper-Limb Lymphedema Treated Aesthetically with Lymphaticovenous Anastomosis using Indocyanine Green Lymphography and Noncontact Vein Visualization

Abstract

We have described a procedure to minimize surgical wounds, in which lymph vessels and skin venules are identified by indocyanine green (ICG) lymphography and the AV300 noncontact visualization system (AccuVein, Cold Spring Harbor, NY), respectively. This approach allows accurate decisions regarding sites of incision for lymphatic venous anastomosis (LVA). This method was applied in a patient with right upper-limb lymphedema after breast cancer therapy. The low-invasive procedure can be used before and during surgery. The incision size is minimal, and the incision site is at the joint area. Thus, we aim to establish this approach as a standard method for identifying lymph vessels and veins that are suitable for LVA. This innovative vascular-imaging machine makes LVA less invasive and more effective without side effects.

Keywords

LVA - lymphatic-venous anastomosis - upper-limb lymphedema - AccuVein - ICG fluorescent lymphography - noncontact vein visualization machine

• References

• 1 O'Brien BM, Sykes P, Threlfall GN, Browning FS. Microlymphaticovenous anastomoses for obstructive lymphedema. Plast Reconstr Surg 1977; 60: 197-211
• 2 Campisi C, Davini D, Bellini C , et al. Lymphatic microsurgery for the treatment of lymphedema. Microsurgery 2006; 26: 65-69
• 3 Koshima I, Kawada S, Moriguchi T, Kajiwara Y. Ultrastructural observations of lymphatic vessels in lymphedema in human extremities. Plast Reconstr Surg 1996; 97: 397-405 ; discussion 406–407
• 4 Koshima I, Nanba Y, Tsutsui T, Takahashi Y, Itoh S. Long-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg. J Reconstr Microsurg 2003; 19: 209-215
• 5 Narushima M, Mihara M, Yamamoto Y, Iida T, Koshima I, Mundinger GS. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg 2010; 125: 935-943
• 6 Mihara M, Uchida G, Hara H , et al. Lymphaticovenous anastomosis for facial lymphoedema after multiple courses of therapy for head-and-neck cancer. J Plast Reconstr Aesthet Surg 2011; 64: 1221-1225
• 7 Ogata F, Azuma R, Kikuchi M, Koshima I, Morimoto Y. Novel lymphography using indocyanine green dye for near-infrared fluorescence labeling. Ann Plast Surg 2007; 58: 652-655
• 8 Ogata F, Narushima M, Mihara M, Azuma R, Morimoto Y, Koshima I. Intraoperative lymphography using indocyanine green dye for near-infrared fluorescence labeling in lymphedema. Ann Plast Surg 2007; 59: 180-184
• 9 Smit JM, Klein S, Werker PM. An overview of methods for vascular mapping in the planning of free flaps. J Plast Reconstr Aesthet Surg 2010; 63: e674-e682
• 10 Mihara M, Nakanishi M, Nakashima M, Narushima M, Koshima I. Utility and anatomical examination of the DIEP flap's three-dimensional image with multidetector computed tomography. Plast Reconstr Surg 2008; 122: 40e-41e