Lymphatic Fistula Treatment: Indocyanine Green Lymphography-guided Microsurgery.

Area of Science:

• Microsurgery
• Vascular Surgery
• Lymphatic System

Background:

• Lymphatic fistulas are common post-surgical complications causing persistent leakage and delayed healing.
• Current management strategies for lymphatic fistulas vary, including conservative measures and surgical ligation.
• Novel microsurgical techniques, such as lymphatic fistula ligation and lymphovenous anastomosis (LVA) with indocyanine green (ICG) lymphography, show potential for improved outcomes.

Purpose of the Study:

• To evaluate the efficacy of a microsurgical approach for treating persistent lymphatic fistulas.
• To assess the outcomes of lymphatic fistula ligation and LVA guided by ICG lymphography.
• To share clinical experience with this novel treatment modality.

Main Methods:

• Retrospective study of 13 patients with persistent lymphatic fistulas.
• Identification and ligation of lymphatic fistulas using ICG lymphography and a surgical microscope.
• Performed additional lymphovenous anastomosis (LVA) in two cases.

Main Results:

• Successfully identified and treated lymphatic fistulas in all 13 patients.
• Achieved wound healing in 12 out of 13 patients following lymphatic ligation.
• Average consultation time was 5 months after fistula onset, with treatment occurring within 3 weeks to 1 year.

Conclusions:

• ICG-guided microsurgical lymphatic vessel ligation, with or without LVA, is a highly effective therapy for persistent lymphatic fistulas.
• This technique shows potential to accelerate wound healing and decrease hospitalization duration.
• Advocates for the preferential use of this microsurgical approach in managing lymphatic fistulas.