Abstract：
BACKGROUND: Although the usefulness of lymphaticovenous anasotmosis (LVA) for lymphedema has been reported, it is difficult to determine where the LVA is to be performed, especially for inexperienced surgeons. This study aimed to establish a map of the LVA site.
METHODS: A total of 105 limbs from 64 patients who underwent lower limb LVA were retrospectively reviewed. Multi-lymphosome indocyanine green (ICG) lymphography (in 35 patients) and lymphatic ultrasound (in all patients) were performed preoperatively and the incision site was determined where dilated lymph vessels and appropriate veins were located in close proximity. The LVA location was identified using a post-operative photograph. Additionally, the degree of lymphatic degeneration at the LVA site was recorded based on the normal, ectasis, contraction, and sclerosis type (NECST) classification.
RESULTS: A total of 206 skin incisions were analyzed. Among them, 161 (75.9%) were medial and 45 (21.2%) were lateral. Among the 85 sites on the calf, 52 (61.2%) were medial and 33 (38.8%) were lateral. Among the 117 sites on the thigh, 106 (90.6%) were medial and 11 (9.4%) were lateral. As the severity of lymphedema progressed, the probability of performing LVA on the lateral calf increased. Among the 202 locations where LVA was performed on the thigh and lower leg, ectasis type was found in 164 sites (81.2%).
CONCLUSIONS: We established an LVA map of the legs based on multi-lymphosome ICG lymphography and lymphatic ultrasound data. Using this LVA map, surgeons can easily predict the location of lymph vessels, thereby improving the success rate of LVA.
METHODS: A total of 105 limbs from 64 patients who underwent lower limb LVA were retrospectively reviewed. Multi-lymphosome indocyanine green (ICG) lymphography (in 35 patients) and lymphatic ultrasound (in all patients) were performed preoperatively and the incision site was determined where dilated lymph vessels and appropriate veins were located in close proximity. The LVA location was identified using a post-operative photograph. Additionally, the degree of lymphatic degeneration at the LVA site was recorded based on the normal, ectasis, contraction, and sclerosis type (NECST) classification.
RESULTS: A total of 206 skin incisions were analyzed. Among them, 161 (75.9%) were medial and 45 (21.2%) were lateral. Among the 85 sites on the calf, 52 (61.2%) were medial and 33 (38.8%) were lateral. Among the 117 sites on the thigh, 106 (90.6%) were medial and 11 (9.4%) were lateral. As the severity of lymphedema progressed, the probability of performing LVA on the lateral calf increased. Among the 202 locations where LVA was performed on the thigh and lower leg, ectasis type was found in 164 sites (81.2%).
CONCLUSIONS: We established an LVA map of the legs based on multi-lymphosome ICG lymphography and lymphatic ultrasound data. Using this LVA map, surgeons can easily predict the location of lymph vessels, thereby improving the success rate of LVA.
摘要：
背景：尽管已经报道了淋巴静脉性吻合术（LVA）对淋巴水肿的有用性，很难确定在哪里执行LVA，尤其是没有经验的外科医生.本研究旨在建立LVA位点的图谱。
方法：回顾性分析64例下肢LVA患者的105条肢体。术前进行了多淋巴体吲哚菁绿（ICG）淋巴造影（35例）和淋巴超声（所有患者），并确定了扩张的淋巴管和适当的静脉靠近的切口部位。使用术后照片确定LVA位置。此外,LVA部位的淋巴变性程度是根据正常情况记录的，扩张,收缩，和硬化类型(NECST)分类。
结果：共分析了206个皮肤切口。其中,内侧161例（75.9％），外侧45例（21.2％）。在小腿上的85个地点中，内侧52例（61.2%），外侧33例（38.8%）。在大腿上的117个部位中，内侧106例（90.6%），外侧11例（9.4%）。随着淋巴水肿的严重程度，对侧小腿进行LVA的可能性增加。在对大腿和小腿进行LVA的202个位置中，在164个地点发现了扩张类型(81.2%)。
结论：我们根据多淋巴细胞ICG淋巴造影和淋巴超声数据建立了腿部的LVA图。使用这张LVA地图，外科医生可以很容易地预测淋巴管的位置，从而提高了LVA的成功率。
方法：回顾性分析64例下肢LVA患者的105条肢体。术前进行了多淋巴体吲哚菁绿（ICG）淋巴造影（35例）和淋巴超声（所有患者），并确定了扩张的淋巴管和适当的静脉靠近的切口部位。使用术后照片确定LVA位置。此外,LVA部位的淋巴变性程度是根据正常情况记录的，扩张,收缩，和硬化类型(NECST)分类。
结果：共分析了206个皮肤切口。其中,内侧161例（75.9％），外侧45例（21.2％）。在小腿上的85个地点中，内侧52例（61.2%），外侧33例（38.8%）。在大腿上的117个部位中，内侧106例（90.6%），外侧11例（9.4%）。随着淋巴水肿的严重程度，对侧小腿进行LVA的可能性增加。在对大腿和小腿进行LVA的202个位置中，在164个地点发现了扩张类型(81.2%)。
结论：我们根据多淋巴细胞ICG淋巴造影和淋巴超声数据建立了腿部的LVA图。使用这张LVA地图，外科医生可以很容易地预测淋巴管的位置，从而提高了LVA的成功率。
