Tokyo, Japan; and Baltimore, Md. From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, and Division of Plastic, Reconstructive, and Maxillofacial Surgery, The Johns Hopkins Hospital.
Plast Reconstr Surg. 2011 May;127(5):1979-1986. doi: 10.1097/PRS.0b013e31820cf5df.
Indocyanine green lymphography has been a highly useful modality in the clinical examination and surgical management of patients with lymphedema. No formal classification system of indocyanine green imaging findings according to the severity of lymphedema exists, however. The purpose of this study was to describe, analyze, and classify characteristic indocyanine green lymphography findings to uniformly guide surgical management of lymphedema using this modality.
Forty-five patients (78 limbs) with lower extremity lymphedema underwent indocyanine green lymphography. All lymphography images were recorded in photographs and videos. Images were reviewed and analyzed to classify characteristic findings according to clinical severity as determined by Campisi clinical lymphedema staging.
Lymphography findings were classifiable into two patterns. Mild cases of lymphedema were characterized by a linear lymphatic channel pattern (linear pattern). In more severe cases, lymphatic channels demonstrated retrograde lymphatic flow (dermal backflow pattern) and diminution or absence of linear channel patterning. Three dermal backflow patterns, splash, stardust, and diffuse, were identified and correlated with the progression of lymphedema severity. These findings supported the generation of a novel anatomical lymphedema severity staging system, the dermal backflow staging system.
Indocyanine green lymphography is a safe, minimally invasive, and useful tool for the surgical evaluation of extremity lymphedema. Characteristic indocyanine green lymphography patterns are consistent and correlate with clinical severity. The dermal backflow staging system can facilitate patient stratification, discussion between referring parties, and surgical planning.
吲哚菁绿淋巴造影术在淋巴水肿患者的临床检查和外科治疗中具有重要作用。然而，目前尚不存在根据淋巴水肿严重程度对吲哚菁绿成像结果进行正式分类的系统。本研究旨在描述、分析和分类吲哚菁绿淋巴造影的特征性发现，以便使用这种方式统一指导淋巴水肿的外科治疗。
45 例（78 侧）下肢淋巴水肿患者行吲哚菁绿淋巴造影术。所有淋巴造影图像均以照片和视频形式记录。对图像进行回顾和分析，根据 Campisi 临床淋巴水肿分期确定的临床严重程度对特征性发现进行分类。
淋巴造影表现可分为两种模式。轻度淋巴水肿表现为线性淋巴通道模式（线性模式）。在更严重的病例中，淋巴通道显示逆行淋巴流动（真皮逆流模式）和线性通道模式的减少或缺失。鉴定出三种真皮逆流模式，即飞溅状、星状和弥漫状，并与淋巴水肿严重程度的进展相关。这些发现支持生成一种新的解剖学淋巴水肿严重程度分期系统，即真皮逆流分期系统。
吲哚菁绿淋巴造影术是一种安全、微创、对四肢淋巴水肿外科评估有用的工具。特征性吲哚菁绿淋巴造影模式具有一致性，并与临床严重程度相关。真皮逆流分期系统有助于患者分层、转诊方讨论和手术计划。
