Multipoint injection indocyanine green lymphography can reduce lymphaticovenular anastomosis surgical time and improve the surgical results for lymphedema

Abstract

Aim: Lymphaticovenular anastomosis (LVA) is the mainstay of surgical treatment of lymphedema now. Indocyanine green (ICG) lymphography is a method for detecting lymphatic pathways and for the clinical evaluation of patients with extremity lymphedema. The essential point of LVA is to find more functional lymphatic vessels. Sometimes, in cases of lymphatic dysfunction, ICG injections into the distal extremities are insufficient. The purpose of this study was to elucidate the effect of multi-injection of ICG lymphography on LVA.Methods: In this study, we injected ICG into the second web of the hands or the first web of the feet. In the multi-injection group, we injected additional ICG in other sites. We observed the presence or absence of a linear pattern at each injection site with a near-infrared camera. Then, we performed LVA and evaluated the circumference change and the operation time.Results: In the multi-injection group, we injected ICG into the upper limb at an average of 2.2 sites (range: 1-3 sites) and the lower limb at an average of 3.2 sites (range: 1-5 sites). The circumference change of upper limbs in the control group was -3.95% ± 1.34% and in the multi-injection group was -6.96% ± 0.88% (P < 0.05). The change in circumference of lower limbs was -5.01% ± 2.2% in the multi-injection group and -2.33% ± 1.77% in the control group (P = 0.003). The mean surgical duration was significantly shortened in the multi-injection group (P < 0.05).Conclusion: By injecting ICG into multiple sites of the affected limbs, we could detect more functional lymphatic vessels during LVA, which was helpful for achieving a successful surgical result