Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, the Republic of Korea.
Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, the Republic of Korea.
J Plast Reconstr Aesthet Surg. 2023 Jul;82:219-228. doi: 10.1016/j.bjps.2023.01.024. Epub 2023 Feb 8.
Indocyanine green (ICG) lymphography is widely used to localize functional lymphatic vessels for lymphaticovenous anastomosis (LVA); however, flow velocity is rarely assessed. We aimed to evaluate the correlation between lymphatic flow velocity and the presence of functional lymphatic vessels.
Data of a total of 924 lymphatic vessels from 273 lymphedema patients who underwent LVA between July 2018 and December 2020 were retrospectively reviewed. Lymph flow velocity was defined by considering the most proximal anatomic location enhanced by ICG at 30 min after injection and categorized into four groups; grade 1 (foot or hand), grade 2 (below knee or elbow), grade 3 (at/above knee or eblow), or grade 4 (axilla or groin). The presence of functional lymphatic vessels, which showed lymphatic fluid flow when the vessels were cut for anastomosis, was compared between the four groups.
A higher rate of functional lymphatic vessels was observed among lymphatic vessels with grade 3 or 4 flow velocity compared with those with grade 1 or 2 flow velocity (67.5% vs. 44.5%; p < 0.001). These findings were consistent with the observations for lymphatic vessels with a non-linear pattern in ICG lymphography (59.4% vs. 26.5%; p < 0.001). The rate of completion of LVA at surgical sites in extremities with grade 3 or 4 flow velocity was 88.1% compared with 65.8% in extremities with grade 1 or 2 velocity (p < 0.001).
Lymph flow velocity grading can be a simple and easy adjunctive method to determine indication for LVA in extremities with lymphedema.
吲哚菁绿（ICG）淋巴造影术广泛用于定位功能性淋巴管以进行淋巴静脉吻合术（LVA）；然而，很少评估流速。我们旨在评估淋巴流速与功能性淋巴管存在之间的相关性。
回顾性分析了 2018 年 7 月至 2020 年 12 月期间接受 LVA 的 273 例淋巴水肿患者的总共 924 条淋巴管的数据。淋巴流速通过考虑在注射后 30 分钟内 ICG 增强的最近端解剖位置来定义，并分为四级；1 级（足或手）、2 级（膝下或肘下）、3 级（膝上或肘上）或 4 级（腋窝或腹股沟）。比较了四个流速组中功能性淋巴管的存在情况，这些淋巴管在吻合时显示淋巴液流动。
与 1 级或 2 级流速相比，3 级或 4 级流速的淋巴管中功能性淋巴管的比例更高（67.5% vs. 44.5%；p < 0.001）。这些发现与 ICG 淋巴造影术非线性模式的淋巴管观察结果一致（59.4% vs. 26.5%；p < 0.001）。3 级或 4 级流速的四肢 LVA 手术部位的完成率为 88.1%，而 1 级或 2 级流速的四肢为 65.8%（p < 0.001）。
淋巴流速分级可以作为一种简单易用的辅助方法，用于确定四肢淋巴水肿患者进行 LVA 的适应证。
