A Retrospective Analysis Of The Clinical Efficacy Of Multiple Injections Of Indocyanine Green (ICG) Fluorescence Lymphography On The Lower Extremity The Lymphatic Venous Anastomosis

Objective: Before lymphaticovenular anastomosis(LVA)of the lower extremities,insufficient linear patterns have sometimes been observed with single-point injection of indocyanine green(ICG).The aim of this study was to investigate the advantages of multipoint injection of indocyanine green(ICG)for fluorescent lymphography in LVA.Methods This study screened 56 patients with unilateral lower extremity lymphedema who underwent LVA between December 2018 and April 2022.Two cohorts of patients were compared: group 1,24 patients,single-point injection of ICG;and group2,32 patients,multiple-point injection of ICG.In group 1,they were injected ICG into the first web space of each foot;and in group 2,they were injected with four additional points,including medial malleolus and lateral malleolus,medial and lateral knees.We collected the operation time,and calculated the ΔLELI(lower extremity lymphedema index),etc.Results Patients in group 2 had shorter operative time(5.01h(3.5-7))than patients in group 1(5.62h(3-7))(p < 0.05).In group 1,the mean ΔLELI is 24.72(-8-83)and the mean ΔLELI in group 2 is 35.82(12-84)(p < 0.05).The mean number of incisions per limb was 4.83(2-6)and 5.22(4-6),respectively(p >0.05).The mean number of lymphatic vessels per limb was 4.29(2-6)and 5.09(4-7),respectively(p < 0.05).The mean number of lymphaticovenular anastomosis performed per limb is 4.21(2-6)and 5.06(4-7),respectively(p < 0.05).Conclusion The current data suggest that multiple injections of indocyanine green could increase the detection rate of functional lymphatic vessels and achieve better surgical effect in patients undergoing LVA.