Pereira Nicolás, López María Antonella, Oñate Vanessa, Roa Ricardo
Department of Plastic Surgery and Burns, Hospital del Trabajador, Santiago, Chile.
Specialized Center for Lymphedema and Lipedema, Santiago, Chile.
Microsurgery. 2025 Sep;45(6):e70115. doi: 10.1002/micr.70115.
When indocyanine green lymphography (ICG-L) fails to display a linear pattern, preoperative planning for lymphovenous anastomosis (LVA) becomes challenging. Given the anatomical symmetry of lymphatics in extremities, the healthy limb can serve as a template for the affected one. This study introduces an accessible technique that uses augmented reality (AR) to mirror the lymphatic anatomy of the unaffected limb onto the affected side to assist in surgical planning.
Twelve patients with unilateral secondary lymphedema of the upper or lower extremity (Stage II or less) were included. After standard ICG-L mapping, the unaffected limb was photographed when it showed a linear lymphatic pattern. The image was mirrored and superimposed onto the affected limb using an AR smartphone app to guide incision planning for LVA. Volume reduction and clinical outcomes were measured postoperatively.
A total of 39 LVAs were successfully performed at the planned locations, with 100% intraoperative accuracy. No modifications or extensions of incisions were needed. Patients experienced an average operative time of 142.5 min. Volume excess was reduced by 47% over a follow-up period of 3-24 months, with a notable reduction in episodes of cellulitis and improvements in symptoms and quality of life.
"Mirror the lymph" is a reliable, low-cost AR-based planning method for identifying lymphatic vessels in patients with unilateral lymphedema when ICG-L mapping shows early dermal backflow. This technique improves surgical precision and efficiency and offers an innovative tool for resource-limited settings.
当吲哚菁绿淋巴造影（ICG-L）未能显示出线性模式时，淋巴静脉吻合术（LVA）的术前规划就变得具有挑战性。鉴于四肢淋巴管的解剖对称性，健康肢体可作为患侧肢体的模板。本研究介绍了一种可及的技术，该技术使用增强现实（AR）将未受影响肢体的淋巴解剖结构映射到患侧，以协助手术规划。
纳入12例上肢或下肢单侧继发性淋巴水肿（II期或以下）患者。在进行标准的ICG-L造影后，当未受影响的肢体显示出线性淋巴管模式时对其进行拍照。使用AR智能手机应用程序将图像镜像并叠加到患侧肢体上，以指导LVA的切口规划。术后测量体积减少情况和临床结果。
共在计划位置成功进行了39例LVA，术中准确率达100%。无需对切口进行修改或延长。患者的平均手术时间为142.5分钟。在3至24个月的随访期内，体积超标减少了47%，蜂窝织炎发作明显减少，症状和生活质量得到改善。
“镜像淋巴”是一种可靠、低成本的基于AR的规划方法，用于在ICG-L造影显示早期真皮反流时识别单侧淋巴水肿患者的淋巴管。该技术提高了手术精度和效率，并为资源有限的环境提供了一种创新工具。
