2009 Volume 21 Issue 1 Pages 189-193
Since April 2006, we have performed lymphaticovenous anastomosis (LVA) using indocyanine green fluorescence lymphography (FL-ICG). The use of FL-ICG in LVA allowed more precise identification of lymphatics and anastomosis to veins. We report the usefulness of this method for treatment of male lymphedema of the lower limbs.
Among the patients who underwent LVA since we introduced FL-ICG, 6 male patients (7 limbs) with lower-limb lymphedema who were followed postoperatively for 6 months or longer were included in the present study.
Indocyanine green (ICG) was injected intracutaneously at several points on the lower extremity, and the dye distribution was observed using a special infrared camera (Photo Dynamic Eye). ICG is taken up into the lymphatics and its spread along with the lymph flow can be monitored. When a lymphatic vessel was visualized by linear flow of ICG, an incision was made at the site and the lymphatic was searched and identified using an operating microscope, and then anatomosed to the cutaneous vein.
Among a total of 7 limbs, 4 were evaluated as excellent, 3 as good, 0 as fair and 0 as poor.
In conventional LVA, identification of the lymphatics depends greatly on the experience of the surgeon. However, the use of FL-ICG allows more accurate identification of the lymphatics and confirmation of lymph flow after anastomosis.
