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Predictive lymphatic mapping: a method for mapping lymphatic channels in patients with advanced unilateral lymphedema using indocyanine green lymphography.

Authors
  • Mihara, Makoto
  • Seki, Yukio
  • Hara, Hisako
  • Iida, Takuya
  • Oka, Aiko
  • Kikuchi, Kazuki
  • Narushima, Mitsunaga
  • Haragi, Makiko
  • Furniss, Dominic
  • Hin-Lun, Lawrence
  • Mitsui, Kito
  • Murai, Noriyuki
  • Koshima, Isao
Type
Published Article
Journal
Annals of plastic surgery
Publication Date
Jan 01, 2014
Volume
72
Issue
6
Pages
706–710
Identifiers
DOI: 10.1097/SAP.0b013e31826a18b1
PMID: 23486121
Source
Medline
License
Unknown

Abstract

In severe lymphedema, indocyanine green lymphography cannot be used to map lymphatic channels before lymphaticovenular anastomosis (LVA) because linear lymphatics cannot be detected in a severely affected leg. Here, we describe a new method, which we refer to as predictive lymphatic mapping, to predict the location of lymphatics for anastomosis in unilateral lymphedema, thereby improving surgical accuracy and efficiency. The approach consists of marking anatomical landmarks and joining selected landmarks with fixed lines. The distance from these fixed lines to lymphatic channels mapped by indocyanine green lymphography in the unaffected leg is then measured, scaled up based on the difference in circumference between the legs, and transposed to the affected leg. To date, we have used this method in 5 cases of unilateral or asymmetric lymphedema of the lower extremities. In no cases have we failed to find a lymphatic channel suitable for LVA within a 2-cm incision. These results suggest that predictive lymphatic mapping is a useful additional tool for surgeons performing LVA under local anesthesia, which will help to improve the accuracy of incisions and the efficiency of surgery.

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