• Takumi Yamamoto, Nana Yamamoto, Yuma Fuse, Mitsunaga Narushima, and Isao Koshima.
• Tokyo, Japan From the Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine; the Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital; and the Department of Plastic and Reconstructive Surgery, University of Tokyo Hospital.
• Plast. Reconstr. Surg. 2018 Dec 1; 142 (6): 924e-930e.

BackgroundSupermicrosurgical lymphaticovenular anastomosis is becoming a useful treatment option for progressive lower extremity lymphedema because of its minimal invasiveness. Finding a lymphatic vessel is a minimum requirement for lymphaticovenular anastomosis surgery, but no study has reported comprehensive analysis on factors associated with lymphatic vessel detection.MethodsOne hundred thirty-four female secondary lower extremity lymphedema patients who underwent indocyanine green lymphography and lymphaticovenular anastomosis without a history of lymphedema surgery were included. Medical charts were reviewed to obtain clinical, indocyanine green lymphographic, and intraoperative findings. Lymphatic vessel detection was defined as positive when one or more lymphatic vessels were found in a surgical field of lymphaticovenular anastomosis. Logistic regression analysis was used to identify independent factors associated with lymphatic vessel detection.ResultsPatient age ranged from 36 to 81 years, duration of edema ranged from 3 to 324 months, and body mass index ranged from 16.2 to 33.3 kg/m. Forty-eight patients (35.8 percent) had a history of radiation therapy, and 76 patients (56.7 percent) had a history of cellulitis. Lymphaticovenular anastomoses were performed in 840 surgical fields, among which lymphatic vessel detection was positive in 807 fields; the overall lymphatic vessel detection rate was 96.1 percent. Multivariate analysis revealed inverse associations in higher body mass index (OR, 0.323; p = 0.008) and the S-region/D-region on indocyanine green lymphography compared with the L-region (OR, 1.049 × 10(-8)/1.724 × 10(-9); p < 0.001/p < 0.001).ConclusionsIndependent factors associated with lymphatic vessel detection were clarified. Lower body mass index and L-region on indocyanine green lymphography are favorable conditions for finding lymphatic vessels in lower extremity lymphedema patients.Clinical Question/Level Of EvidenceRisk, III.

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