Related Experiment Video
Updated: Apr 25, 2026
A Revised Method for Inducing Secondary Lymphedema in the Hindlimb of Mice
Published on: November 2, 2019
The 50 most-cited publications in lymphatic surgery: A bibliometric analysis
Abdullah A Al Qurashi1,2,3, Pharel Njessi1,2, Hatan Mortada4,5
1Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur et du Sport, University Côte d'Azur, Nice, France.
Background:
Lymphatic surgery has evolved from palliative debulking procedures to physiologic reconstruction using microsurgical and supermicrosurgical techniques. Despite this progress, the publications that have most influenced this evolution have not been systematically examined. This study aimed to analyze the 50 most-cited publications in lymphatic surgery, assessing their bibliometric characteristics, study designs, levels of evidence, and thematic contributions to lymphedema surgical management.
Methods:
The Web of Science Core Collection was searched for articles on surgical treatment of lymphedema from inception to November 7, 2025. The 50 most-cited articles were identified and analyzed for citation count, citation density (citations per year), authorship, geographic origin, journal distribution, and keyword frequency. Studies were categorized by design and evaluated according to the Oxford Centre for Evidence-Based Medicine levels of evidence. Concise summaries were generated to facilitate access to key findings.
Results:
Published between 2004 and 2023, the top 50 articles accumulated 4612 citations (mean 92.2, median 75.5). Citation density ranged from 3.9 to 32.5 citations per year. Plastic and Reconstructive Surgery was the most represented journal (n = 14). Asian institutions predominated, with Japan (n = 16) and Taiwan (n = 11) accounting for 54% of publications. Case series were the most common study design (n = 24). Most studies provided Level 4 or 5 evidence (74%), although two Level 2 randomized controlled trials were identified. Keyword analysis identified supermicrosurgery, lymphaticovenular anastomosis, and indocyanine green lymphography as the most recurring technical concepts.
Conclusions:
This bibliometric analysis highlights seminal publications underlying the development of supermicrosurgical techniques such as lymphaticovenous anastomosis and vascularized lymph node transfer. The results demonstrate a strong Eastern contribution to innovation. While observational studies predominate, the near-total absence of Level 1 evidence and the presence of only two Level 2 trials underscore the need for well-designed prospective comparative studies to establish standardized treatment algorithms. Level of evidence: IV.
Related Concept Videos
01:16Lymphatic Vessels and Lymph Transport
This one-way system allows fluids, solutes, and even pathogens to enter but prevents their return to the intercellular...
01:15Development of the Lymphatic System
The first lymph sacs to form are the paired jugular lymph sacs located at the junction of the internal jugular and subclavian veins. From these sacs, lymphatic capillary plexuses extend to the thorax, upper limbs, neck, and head, eventually forming lymphatic vessels. Each jugular lymph sac maintains a...
01:20Overview of the Vascular System
01:23Detailed Structure and Function of Lymph Nodes
From a histological perspective, lymph nodes can be split into two main areas: the superficial cortex and the deep medulla. The outer cortex is populated by dendritic cells, macrophages, and B lymphocytes, which are densely packed into follicles. When these B-lymphocytes are presented...
01:18Lymphoid Cells and Tissues
Lymphoid cells consist of various types of immune system cells. These include B and T lymphocytes, which are responsible for producing antibodies and killing infected cells, respectively. Dendritic cells act as messengers between the innate and adaptive...