From Failure to Flow: Indocyanine Green Improves Preoperative Mapping for Lymphaticovenular Anastomosis After Negative Contrast-enhanced Ultrasonography.

Authors

Xinyu Lou, Johnson Boey, Longbiao Yu, Jingjing Wen, Songhua Liu, Pengzhou Huang, Zhiying Chen, Qing Xie, Zhegang Zhou

Published in

Plastic and reconstructive surgery. Global open. Volume 14. Issue 10. Pages e8146. Epub Oct 06, 2026.

Abstract

Accurate identification of functional lymphatic vessels is essential for lymphaticovenular anastomosis (LVA) but it remains challenging. Contrast-enhanced ultrasound (CEUS) is increasingly used for preoperative mapping; however, failure to detect vessels of adequate caliber often leads to deferral of LVA. We report a case where CEUS indicated no suitable lymphatic vessels intraoperatively, yet a high-quality LVA was successfully performed using preoperative indocyanine green (ICG) lymphography-guided exploration. Preoperative ICG mapping revealed limited linear channels and dermal backflow, guiding targeted incisions. Intraoperatively, functional lymphatic vessels and suitable venules (0.3-0.4 mm) were identified despite failed CEUS-guided localization, and end-to-end anastomosis was completed. Postoperatively, maximal interlimb circumference difference decreased from 2.5 to 1.7 cm, with symptomatic relief. This is the first case demonstrating that when CEUS-guided intraoperative localization fails, individualized ICG findings can guide empirical incisions to identify better lymphatic vessels for LVA. A multimodal approach may improve patient outcomes.

PMID:
42841095
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.