Reply: Correlations between Tracer Injection Sites and Lymphatic Pathways in the Leg: A Near-Infrared Fluorescence Lymphography Study

Shinaoka, Akira; Koshimune, Seijiro; Yamada, Kiyoshi; Kumagishi, Kanae; Suami, Hiroo; Kimata, Yoshihiro; Ohtsuka, Aiji

doi:10.1097/prs.0000000000007014

Cited by 11 publications

(17 citation statements)

References 2 publications

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“…This finding regarding the course of lymphatic vessels is similar to that of a human cadaveric study. 17 In the central dorsum distal to the MP joint level, lymphatic vessels and veins run parallel, with similar sizes in all trotters. Any kind of anastomosis would be applicable in the dorsal points and considered feasible for LVA training.…”

Section: Discussionmentioning

confidence: 90%

Establishing a Lymphatic Venous Anastomotic Training Model in Pig Trotters

Kato

Kurita

Mito

et al. 2021

J Reconstr Microsurg

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Background Lymphatic venous anastomosis (LVA) is a widely accepted surgical procedure for lymphedema. To obtain the best outcomes, surgeons should be well trained. A recent study introduced an LVA training model using pig trotters for their utility and structural similarity to human tissues. However, details regarding the utilization of anastomosis models, such as feasible points for training based on vessel anatomy, have not been clarified. Therefore, we assessed the anatomical details of lymphatic vessels and veins of trotters to establish a practical training model of LVA. Methods Ten frozen trotters were used. After thawing at room temperature, indocyanine green fluorescent lymphography was used to visualize the lymphatic course. To dissect the lymphatic vessels and veins from the distal to the proximal end, whole skins were detached thoroughly from the plantar side. Data from the lymphatic vessels and veins were collected based on their courses, diameters, and layouts to clarify adjacent points feasible for LVA training. Results Both lymphatic vessels and veins were classified into four major courses: dorsal, medial, lateral, and plantar. The majority were dorsal vessels, both lymphatic vessels and veins. The adjacent points were always found in the distal dorsum center and were especially concentrated between the metacarpophalangeal (MP) joint and central interphalangeal crease, followed by the medial and lateral sides. Conclusion The most relevant point for LVA surgical training in the trotter was the dorsal center distal to the MP joint, where parallel vessels of similar sizes were found in all cases. This practical LVA surgical model would improve surgeon skills in not only anastomosis but also preoperative fluorescent lymphography.

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Section: Discussionmentioning

confidence: 90%

Establishing a Lymphatic Venous Anastomotic Training Model in Pig Trotters

Kato

Kurita

Mito

et al. 2021

J Reconstr Microsurg

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“…MRL images were obtained after subcutaneous injection of 1.0 mL meglumine gadoterate as a contrast agent into 4 sites on each foot according to Shinaoka's report on indocyanine green lymphography (ICG-L): below the medial malleoli, the first interdigital space, the midpoint between the head of the fifth metatarsal bone and the lateral malleoli, and below the lateral malleoli. 18 A local anesthesia was injected prior to the contrast agent.…”

Section: Methodsmentioning

confidence: 99%

Impact of Magnetic Resonance Lymphography on Lymphaticolvenular Anastomosis for Lower-Limb Lymphedema

Yasunaga

Kinjo²,

Nakajima³

et al. 2021

J Reconstr Microsurg

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Background Although several investigations have described the safety, utility, and precision of magnetic resonance lymphography (MRL) as a preoperative examination for lymphaticovenular anastomosis (LVA), it is unclear how much MRL assistance impacts LVA results. The present study aimed to clarify the outcome of MRL-assisted LVA for leg lymphedema using body water measurements obtained by bioelectrical impedance analysis. Methods The water reductive effect of MRL-assisted LVA in female secondary leg lymphedema patients was compared with that of non-MRL-assisted controls in this retrospective study. In the MRL-assisted group, all LVA candidates underwent MRL prior to surgery, and the lymphatic vessels to be anastomosed were primarily determined by MRL findings. The body water composition of the treated legs was assessed before LVA and at 6 months postoperatively using a multi-frequency bioelectrical impedance analyzer. Results Twenty-three patients in the MRL-assisted study group and an equal number in the non-MRL-assisted control group were analyzed. Although mean leg water volume before LVA, mean excess water volume of the affected leg before LVA, and number of anastomoses created were comparable between the groups, the water volume reduction (1.02 L versus 0.49 L; 95% confidence interval [CI]: 0.03–1.03, p < 0.05) and edema reduction rate (46.7% versus 27.2%; 95% CI: 3.7–35.5%, p < 0.05) in the MRL-assisted group were significantly greater than in controls. Conclusion Preoperative MRL-assisted lymph vessel visualization and selection appeared to significantly enhance the water reductive effect of LVA for International Society of Lymphology classification stage 2 leg lymphedema. MRL also helped to reliably identify lymphatic vessels for anastomosis. Without increasing the number of anastomoses, LVA could be performed more effectively by better detecting stagnant lymphatic vessels using MRL.

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“…Major disadvantages of ICG lymphography include the fact that it cannot depict lymphatic vessels deeper than 1.5-2 cm under the skin and does not provide any significant soft-tissue anatomic information. A recent study using ICG lymphography showed that the lower extremity lymphatic vessels are divided into four distinct anatomic and functional groups (anteromedial, anterolateral, posteromedial, and posterolateral) (6). Limitations of that study and of ICG lymphography studies in general are that the relationship between a lymphatic group and its regional lymph nodes could not be determined due to its limited penetration depth.…”

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confidence: 88%