Patient characteristics may affect the lymphatic staining ability of Indocyanine green and Patent blue during lymphaticovenous anastomosis

Issue title: Selected articles from the 3rd Joint Meeting of The European Society for Clinical Hemorheology and Microcirculation (ESCHM) , The International Society for Clinical Hemorheology (ISCH) and The International Society of Biorheology (ISB), Regensburg, Germany, 28 – 30 September 2023

Guest editors: L. Prantl, A. Krueger-Genge and F. Jung

Article type: Research Article

Authors: Biermann, Niklas^{; *} | Eschenbacher, Elisabeth | Brébant, Vanessa | Heine, Norbert | Brix, Eva | Prantl, Lukas | Anker, Alexandra M.

Affiliations: Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany

Correspondence: [*] Corresponding author: Niklas Biermann, M.D., Department of Plastic, and Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, D-93053 Regensburg, Germany. Tel.: +49 941 944 6763; Fax: +49 941944 6948; E-mail: niklas.biermann@ukr.de.

Abstract: BACKGROUND:The use of dyes like Indocyanine green (ICG) and Patent blue facilitates the identification of lymphatic vessels during lymphaticovenous anastomosis (LVA) surgery. However, some patients experience “staining failure”. In these cases, no stained lymphatic vessels can be detected, making supermicrosurgical LVA even more complex. OBJECTIVE:This study aims to investigate patient-related factors that may interfere with lymphatic vessel staining during LVA. METHODS:A retrospective study was conducted on 30 patient charts, focusing on patient characteristics and the staining quality of ICG and Patent blue dye. Statistical analyses were performed to identify correlations between variables. RESULTS:Significant correlations were found between higher age and secondary lymphedema, longer duration of lymphedema in male patients until surgery and reoccurring cellulitis and Patent blue staining. Notably, recurrent infections to the lymphatic system resulted in inferior staining ability during LVA surgery. CONCLUSIONS:Due to staining failure the detection of functional lymphatic vessels remains challenging in LVA surgery. A more extensive preoperative workup is recommended for patients with recurrent cellulitis to optimize surgical feasibility and procedure quality in LVA treatment for lymphedema.

Keywords: Lymphedema, lymphedema surgery, lymphaticovenous anastomosis, lymphaticovenous bypass, LVA, Indocyanine green, Patent blue dye, blue dye, lymphography

DOI: 10.3233/CH-238112

Journal: Clinical Hemorheology and Microcirculation, vol. 86, no. 1-2, pp. 153-158, 2024