Annals of Plastic Surgery

Skip Navigation LinksHome > January 2014 - Volume 72 - Issue 1 > Minimally Invasive Lymphatic Supermicrosurgery (MILS): Indoc...
Annals of Plastic Surgery:
doi: 10.1097/SAP.0b013e3182605580

Minimally Invasive Lymphatic Supermicrosurgery (MILS): Indocyanine Green Lymphography-Guided Simultaneous Multisite Lymphaticovenular Anastomoses via Millimeter Skin Incisions

Yamamoto, Takumi MD; Narushima, Mitsunaga MD; Yoshimatsu, Hidehiko MD; Seki, Yukio MD; Yamamoto, Nana MD; Oka, Aiko MD; Hara, Hisako MD; Koshima, Isao MD

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Abstract: Among various surgical treatments, lymphaticovenular anastomosis (LVA), which bypasses congested lymph into venous circulation, is the least invasive surgical treatment. However, it usually entails skin incisions of around 3 cm, and operation time of around 4 hours. With multiple supermicrosurgeons under guidance of indocyanine green lymphography, LVAs can be simultaneously performed under local anesthesia within approximately 2 hours via small skin incisions with length less than 1 cm, allowing minimally invasive lymphatic supermicrosurgery (MILS). We performed MILS on 11 limbs of compression-refractory peripheral lymphedema cases. Length of skin incision for LVA ranged from 1 to 9 mm. Average operation time was 1.82 hours. Of the11 limbs, 10 showed postoperative volume reduction. Indocyanine green lymphography clearly visualizes superficial lymph flows, which helps us to decide precise skin incision sites and find lymphatic vessels in LVA surgery, shortening skin incision length and operation time. Minimally invasive lymphatic supermicrosurgery can serve as the most reasonable treatment of compression-refractory peripheral lymphedema.

© 2014 by Lippincott Williams & Wilkins


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