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Lymphatic anatomy and injection sites for indocyanine green lymphography in the posterior thigh

Published:August 08, 2020DOI:https://doi.org/10.1016/j.bjps.2020.05.103
      We read the article “Multilymphoscome injection indocyanine green lymphography can detect more lymphatic vessels than lymphoscintigraphy in lymphedematous limbs” by Hara et al.
      • Hara H.
      • Mihara M.
      Multilymphoscome injection indocyanine green lymphography can detect more lymphatic vessels than lymphoscintigraphy in lymphedematous limbs.
      We agree with their conclusive statements of better lymphatic localization with multi-site injection indocyanine green (ICG) lymphography than lymphoscintigraphy. It is important to understand precise lymphatic anatomy of the extremity for the treatment of lymphedema, especially lymphovenous anastomosis (LVA) surgery.
      • Yamamoto T.
      • Narushima M.
      • Doi K.
      • et al.
      Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns.
      • Yamamoto T.
      • Kikuchi K.
      • Yoshimatsu H.
      • et al.
      Ladder-shaped lymphaticovenular anastomosis using multiple side-to-side lymphatic anastomoses for a leg lymphedema patient.
      • Yamamoto T.
      • Yamamoto N.
      • Yoshimatsu H.
      • et al.
      Factors associated with lymphosclerosis: an analysis on 962 lymphatic vessels.
      • Yamamoto T.
      • Yamamoto N.
      • Kageyama T.
      • et al.
      Technical pearls in lymphatic supermicrosurgery.
      The lymphatic anatomy in the posterior thigh is yet to be fully clarified. Most previous studies and textbook describe that posterior thigh lymph flows start from the posterior midline to the inguinal lymph nodes through medial or lateral aspect of the thigh; the posteromedial and the posterolateral pathways. However, there is no study showing that the posterior midline is the watershed or borderline between posteromedial and posterolateral thigh lymphatic pathways.
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      References

        • Hara H.
        • Mihara M.
        Multilymphoscome injection indocyanine green lymphography can detect more lymphatic vessels than lymphoscintigraphy in lymphedematous limbs.
        J Plast Reconstr Aesthet Surg. 2020; 73: 1025-1030
        • Yamamoto T.
        • Narushima M.
        • Doi K.
        • et al.
        Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns.
        Plast Reconstr Surg. 2011; 127: 1979-1986
        • Yamamoto T.
        • Kikuchi K.
        • Yoshimatsu H.
        • et al.
        Ladder-shaped lymphaticovenular anastomosis using multiple side-to-side lymphatic anastomoses for a leg lymphedema patient.
        Microsurgery. 2014; 34: 404-408
        • Yamamoto T.
        • Yamamoto N.
        • Yoshimatsu H.
        • et al.
        Factors associated with lymphosclerosis: an analysis on 962 lymphatic vessels.
        Plast Reconstr Surg. 2017; 140: 734-741
        • Yamamoto T.
        • Yamamoto N.
        • Kageyama T.
        • et al.
        Technical pearls in lymphatic supermicrosurgery.
        Glob Health Med. 2020; 2: 29-32https://doi.org/10.35772/ghm.2019.01010

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