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Indocyanine Green Lymphographic Signs of Lymphatic Collateral Formation in Lower Extremity Lymphedema After Cancer Resection

Tashiro, Kensuke MD; Shibata, Takashi MD; Mito, Daisuke MD; Ishiura, Ryohei MD; Kato, Motoi MD; Yamashita, Shuji MD; Narushima, Mitsunaga MD; Iida, Takuya MD; Koshima, Isao MD

doi: 10.1097/SAP.0000000000000599
Reconstructive Surgery

Indocyanine green lymphography has recently been used to assess lymphatic vessel function in lymphedema patients. Postoperative collateral lymphatic vessels toward ipsilateral axillary lymph nodes are rarely seen above the umbilical level in lower lymphedema patients. Between January 2012 and December 2014, we performed indocyanine green lymphography of 192 limbs in 96 lower extremity lymphedema cases. As a result, dermal back flow appeared in 95 cases, with 38 in the lower abdominal area and 31 in the genital area. We confirmed 3 cases of superficial lymphatic collateral ways extending above the umbilical level to the axillary lymph nodes. All 3 cases had similarity in lower abdominal edema, so excessive lymphatic fluid in the lower abdomen was assumed to be the cause. Lymphatic collateral ways from abdomen to axillary lymph nodes in this study was likely to be designed to prevent the progress of lymphedema.

From the Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan.

Received March 14, 2015, and accepted for publication, after revision June 18, 2015.

Conflicts of interest and sources of funding: none declared.

Reprints: Kensuke Tashiro, MD, Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku Tokyo 113-8655, Japan. E-mail:

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