Accuracy of Mirror Image Mapping of Lymphatic Tract for High-stage and Reoperative Lymphaticovenular Anastomosis: Intraoperative Analysis and Early Clinical Outcome

Abstract

Background: Indocyanine green lymphography (ICGL) generally has a nonlinear pattern in advanced-stage lymphedema. Despite the lack of a linear pattern ICGL, lymphatic vessels have been discovered in several studies. The purpose of this work was to establish lymphatic mapping utilizing information from the contralateral limb and to illustrate the symmetry of lymphatic systems. Methods: Data were retrospectively collected from 81 patients who underwent lymphaticovenular anastomosis (LVA) using the contralateral mapping technique during 2018 to 2022. The sensitivity, specificity, accuracy, and negative and positive predictive values of this technique were calculated and analyzed. Results: Lymphatic vessels were identified in 85.2% of the upper and 82.3% of the lower limb presumed sites using the contralateral mapping technique. The positive predictive value for successful LVA anastomosis was 93.8% for upper limb and 92.3% for lower limb cases. This mirror image technique’s accuracy was 91.7% and 91.1%, for the upper limb and lower limb group, respectively. Between reoperative and new LVA cases, there was no statistically significant difference in the number, type, or diameter of lymphatic vessels or number of anastomoses. Conclusions: LVA with contralateral mapping technique is an effective method for patients with high-stage lymphedema with a nonlinear pattern on ICGL.