Accelerated Lymph Flow in Early-Stage Secondary Lymphedema Detected by Indocyanine Green Fluorescence Lymphography

Akira Shinaoka; Seijiro Koshimune; Kiyoshi Yamada; Kumiko Matsumoto; Masako Honda; Maki Miyake; Hiromi Furuichi; Atsushi Hongo; Yoshihiro Kimata

doi:10.1055/s-0037-1603740

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2017; 33(08): 596-602
DOI: 10.1055/s-0037-1603740

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Accelerated Lymph Flow in Early-Stage Secondary Lymphedema Detected by Indocyanine Green Fluorescence Lymphography

Akira Shinaoka

¹Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan

²Department of Plastic and Reconstructive Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan

,

Seijiro Koshimune

¹Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan

²Department of Plastic and Reconstructive Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan

,

Kiyoshi Yamada

¹Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan

,

Kumiko Matsumoto

¹Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan

,

Masako Honda

³Department of Nursing, Okayama University Hospital, Okayama, Japan

,

Maki Miyake

³Department of Nursing, Okayama University Hospital, Okayama, Japan

,

Hiromi Furuichi

²Department of Plastic and Reconstructive Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan

,

Atsushi Hongo

²Department of Plastic and Reconstructive Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan

,

Yoshihiro Kimata

¹Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, Okayama, Japan

› Institutsangaben

Abstract

Background The purpose of this study was to evaluate the lymph function of the lower extremities and to identify early symptoms of lymph dysfunction in secondary lymphedema by observing lymph flow with indocyanine green (ICG) fluorescence lymphography (LG).

Methods We retrospectively evaluated the lymph flow of 108 limbs in 54 female patients with leg lymphedema secondary to pelvic lymphadenectomy for gynecological carcinoma and 14 limbs in 7 female controls without a history of pelvic lymphadenectomy or radiotherapy. ICG was injected into four points at the distal part of the lower extremity. Lymph flow was evaluated by measuring the proximal point where the ICG could be observed 5 minutes after rest and 15 minutes after a walking exercise.

Results In the controls, lymph flow was stable at rest and was well enhanced by exercise. In patients with early-stage lymphedema, lymph flow was already enhanced at rest (p = 0.005) and was further enhanced by exercise. In advanced-stage lymphedema, lymph flow was not enhanced, even by exercise (p = 0.001).

Conclusion ICG-LG could evaluate lymph flow and functions of lymph systems and detect accelerated lymph flow in early-stage secondary lymphedema. Detecting accelerated lymph flow may facilitate early detection and treatment of secondary lymphedema.

Keywords

lymphedema - accelerated lymph flow - lymphaticovenous anastomosis

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