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Reverse Lymph Node Mapping Using Indocyanine Green Lymphography: A Step Forward in Minimizing Donor-Site Morbidity in
Gemma Pons1, Usama Abdelfattah1, Jose Sarria1
1From the Departments of Plastic and Reconstructive Surgery and Nuclear Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autonòma de Barcelona; and the Department of Plastic and Reconstructive Surgery, Al-Azhar University Hospitals.
Plastic and Reconstructive Surgery
|February 10, 2021
Summary
Radioisotope-free reverse lymphatic mapping using indocyanine green dye successfully identifies key lymph nodes for transfer, preventing lymphedema. This safer, reproducible technique enhances lymph node flap surgery for lymphedema patients.
Area of Science:
- Microsurgery
- Lymphedema Management
- Surgical Navigation
Background:
- Reverse lymphatic mapping is vital for lymph node flap harvesting to prevent donor-site lymphedema.
- Current radioisotope-based techniques are complex and not widely available.
- A novel, radioisotope-free method using indocyanine green and Patent Blue dye is introduced.
Purpose of the Study:
- To evaluate the efficacy of radioisotope-free reverse lymphatic mapping using indocyanine green and Patent Blue dye.
- To compare this technique with traditional radioisotope scanning for lymph node transfer.
- To assess the safety and reproducibility of the novel mapping method.
Main Methods:
- A prospective study involved patients undergoing free vascularized groin lymph node transfer for postmastectomy lymphedema.
- Indocyanine green and Patent Blue dye were injected into the foot and flap, respectively.
- Lymph node localization was performed using indocyanine green lymphography and a gamma probe.
Main Results:
- Thirty-nine patients underwent lymph node transfer with successful navigation of draining inguinal lymph nodes.
- The blue-stained lymphatics were accurately targeted for transfer.
- No instances of donor-site lymphedema were reported, and lower extremity lymphatic drainage was preserved.
Conclusions:
- Indocyanine green lymphography provides results comparable to technetium-99 isotope scanning for reverse lymphatic mapping.
- Indocyanine green offers superior safety, reproducibility, and avoids radioisotope-related complexities and hazards.
- This technique is a viable and advantageous alternative for lymph node flap procedures.
