Manon Czedik-Eysenberg1, Johannes Steinbacher1, Brigitte Obermayer2, Hidehiko Yoshimatsu3, Hisako Hara4, Makoto Mihara4, Chieh-Han J Tzou1,5, Stefan Meng6,7. 1. Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior (Krankenhaus Goettlicher Heiland), Vienna, Austria. 2. Department of Surgery, Hospital of Divine Savior, Vienna, Austria. 3. Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan. 4. Department of Lymphatic and Reconstructive Surgery, JR Tokyo General Hospital, Tokyo, Japan. 5. Medical Faculty, Sigmund Freud University, Vienna, Austria. 6. Department of Radiology, KFJ Hospital, Vienna, Austria. 7. Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
Abstract
BACKGROUND: The current standard to locate lymphatic vessels for lymphovenous anastomosis (LVA) is the use of indocyanine green (ICG)-lymphangiography. Due to fluid retention and fibrosis of tissue in patients with lymphedema, often present in Caucasian patients, vessels deeper than 0.5 cm below the dermis cannot be visualized. We present our experiences with ultrasound in locating deeper lymphatic vessels in lower extremities. MATERIALS AND METHODS: In total, 28 patients with lymphedema and positive lymphoscintigraphy were included. With ultrasound, we located 82 lymphatic vessels in lower extremities preoperatively without the use of ICG marking. Vessel diameter, depth, and exact location were examined. Using a coordinate system, a mapping of the detected lymphatic vessels was created. The ultrasound findings were confirmed under microscope and ICG intraoperatively. RESULTS: In all, we detected 28 Caucasian patients and 82 lymphatic vessels with ultrasound preoperatively. On average, we found three lymphatic vessels (range, 2-6) at each patient. Of the ultrasound-detected lymphatic vessels, 90.2% could be verified intraoperatively under a microscope. Before skin incision, lymphatic vessels could be visualized in 40% of our patients with ICG. In the mapping of the lymphatic vessels, we found no significant pattern. CONCLUSION: Ultrasound can precisely detect lymphatic vessels for efficient LVA operation without the prior use of ICG-lymphangiography.
BACKGROUND: The current standard to locate lymphatic vessels for lymphovenous anastomosis (LVA) is the use of indocyanine green (ICG)-lymphangiography. Due to fluid retention and fibrosis of tissue in patients with lymphedema, often present in Caucasian patients, vessels deeper than 0.5 cm below the dermis cannot be visualized. We present our experiences with ultrasound in locating deeper lymphatic vessels in lower extremities. MATERIALS AND METHODS: In total, 28 patients with lymphedema and positive lymphoscintigraphy were included. With ultrasound, we located 82 lymphatic vessels in lower extremities preoperatively without the use of ICG marking. Vessel diameter, depth, and exact location were examined. Using a coordinate system, a mapping of the detected lymphatic vessels was created. The ultrasound findings were confirmed under microscope and ICG intraoperatively. RESULTS: In all, we detected 28 Caucasian patients and 82 lymphatic vessels with ultrasound preoperatively. On average, we found three lymphatic vessels (range, 2-6) at each patient. Of the ultrasound-detected lymphatic vessels, 90.2% could be verified intraoperatively under a microscope. Before skin incision, lymphatic vessels could be visualized in 40% of our patients with ICG. In the mapping of the lymphatic vessels, we found no significant pattern. CONCLUSION: Ultrasound can precisely detect lymphatic vessels for efficient LVA operation without the prior use of ICG-lymphangiography.
Authors: Saskia van Heumen; Jonas J M Riksen; Wichor M Bramer; Gijs van Soest; Dalibor Vasilic Journal: Ann Surg Oncol Date: 2022-09-28 Impact factor: 4.339
Authors: Zulqarnain Masoodi; Johannes Steinbacher; Ines E Tinhofer; Manon Czedik-Eysenberg; Balazs Mohos; Julia Roka-Palkovits; Nina Huettinger; Stefan Meng; Chieh-Han John Tzou Journal: Plast Reconstr Surg Glob Open Date: 2022-04-19