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Practical Lymphatic Ultrasound for Supermicrosurgical Lymphaticovenous Anastomosis: Preoperative Lymphatic Mapping
Paloma Malagón1, Takumi Yamamoto2
1From the Department of Plastic and Reconstructive Surgery, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain.
Annals of Plastic Surgery
|May 22, 2025
Summary
High-frequency ultrasound (HFUS) provides a standardized method for preoperative mapping of lymphovenous anastomosis (LVA) in lymphedema patients. This technique effectively identifies vessels, reduces limb volume, and improves patient quality of life.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Lymphedema Management
Background:
- Ultrasound (US) is valuable for mapping lymph vessels and veins for lymphovenous anastomosis (LVA).
- However, US is operator-dependent and requires experience.
- High-frequency US (HFUS) offers advantages for preoperative LVA planning.
Purpose of the Study:
- To describe a standardized method for preoperative LVA mapping using HFUS in B mode.
- To evaluate the efficacy of HFUS in identifying lymphatics and veins for LVA surgery.
Main Methods:
- A guide was developed based on experiences with HFUS for LVA preoperative planning.
- Data from patients with lower limb lymphedema undergoing LVA were analyzed.
- HFUS with an 18 MHz linear transducer in B mode was used for mapping the day before surgery.
Main Results:
- A step-by-step standardized method for HFUS-guided LVA preoperative planning was detailed.
- The success rate for identifying lymph vessels was 99.7%.
- Significant improvements were observed in limb volume index (P = 0.002) and quality of life (P < 0.001).
Conclusions:
- A standardized HFUS method enables effective preoperative mapping for LVA.
- This approach aids in reducing limb volume and enhancing the quality of life for lymphedema patients.
