Abstract
Objectives: Reports of evaluations of normal superficial lymph flow using indocyanine green (ICG) fluorescence lymphography are rare. Here we investigated the normal superficial ICG fluorescence (IF) lymph flows and the characteristic IF images of lymphedema. We also evaluated the effect of complete decongestive physiotherapy (CDP) as a rehabilitation approach for lymphedema in the upper limbs, using IF imaging.
Methods: Five normal volunteers and three patients with breast cancer-related lymphedema (BCRL) were the subjects. ICG solution (0.4 mL) was injected subcutaneously at three points between the bases of the fingers, and we then observed the superficial IF lymph flow of the upper limbs using a near-infrared camera system.
Results: In the observation of normal superficial lymph flows of the upper limb, there were two major lymph flows, one to the radial side and the other to the ulnar side, which were clearly recognized by the IF lymphography. Those lymph flows were building a network along with the lymphatic flow. Many of the lymphatic back flow images of the upper arms of the BCRL patients showed “dermal backflow (DB).” In one patient, the DB decreased sharply after she underwent CDP for 1 year.
Conclusions: We evaluated the normal and abnormal superficial lymphatic flows in the upper limbs in real time by an IF method. We expect that these characteristic images will not only help elucidate the anatomy of the lymph system but also be used in therapeutic procedures for lymphedema of the upper limbs in patients with BCRL.
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Ohtsubo, S., Kusano, M., Mori, M. (2016). Superficial Lymph Flow of the Upper Limbs Observed by an Indocyanine Green Fluorescence Method: Lymph Flow in Healthy Persons and Patients with Breast Cancer-Related Lymphedema. In: Kusano, M., Kokudo, N., Toi, M., Kaibori, M. (eds) ICG Fluorescence Imaging and Navigation Surgery. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55528-5_39
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