We demonstrated the differences in the anatomy of the lymphatic system between healthy upper limbs and lymphedematous limbs. We observed the reticular structures only in the lymphedematous limbs. These findings are similar to the “dermal backflow” sign observed in lymphangiography and lymphoscintigraphy.4,5
Using this indocyanine green system, an incision can be made precisely over the collecting lymphatic vessels. This allows for the prompt identification of the functional lymphatic vessels and has the potential to significantly improve the outcomes of lymphovenous shunt operations.
Hiroo Suami, M.D., Ph.D.
David W. Chang, M.D.
University of Texas M. D. Anderson Cancer Center
Kiyoshi Yamada, M.D.
Yoshihiro Kimata, M.D.
The authors have no financial interest to declare in relation to the content of this article.
1. Kitai T, Inomoto T, Miwa M, Shikayama T. Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer. Breast Cancer
2. Unno N, Inuzuka K, Suzuki M, et al. Preliminary experience with a novel fluorescence lymphography using indocyanine green in patients with secondary lymphedema. J Vasc Surg.
3. Ogata F, Narushima M, Mihara M, Azuma R, Morimoto Y, Koshima I. Intraoperative lymphography using indocyanine green dye for near-infrared fluorescence labeling in lymphedema. Ann Plast Surg.
4. Feldman MG, Kohan P, Edelman S, Jacobson JH II. Lymphangiographic studies in obstructive lymphedema of the upper extremity. Surgery
5. Sty JR, Boedecker RA, Scanlon GT, Babbitt DP. Radionuclide “dermal backflow” in lymphatic obstruction. J Nucl Med.
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