{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T14:12:57Z","timestamp":1775743977982,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,9,27]],"date-time":"2017-09-27T00:00:00Z","timestamp":1506470400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Supermicrosurgical lymphatic\u2010venous anastomosis (LVA) can improve limbs lymphedema. We describe a technique that we employ for preoperative lymphatic mapping of the upper limb (UL), when indocyanine green (ICG) lymphography shows only dermal backflow (DB) and no lymphatic vessel is detectable.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>Sixteen patients undergoing LVA for unilateral UL lymphedema, showing \u201cstardust\u201d or \u201cdiffuse\u201d DB pattern, were included. Demographic, clinical data, and limbs measurements were recorded. LymQoL arm questionnaire was administered. Mean age of patients was 58.8\u00a0\u00b1\u00a013.1\u00a0years. Fifteen were females and 1 male. Lymphatic anatomy of the healthy limb was investigated by ICG lymphography and reported on the affected limb by a four steps technique: marking the main lymphatic pathway on the healthy limb, measuring of the distances at seven levels between the pathway and a line joining fixed landmarks, reporting these measurements on the affected limb with a correction proportional to the degree of swelling, marking skin incisions at the intersection of this pathway with venules, individuated by near infrared light system. Results were analyzed by postoperative questionnaire and changes of limb measurements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For every limb, we could find 3\u00a0\u00b1\u00a00.73\u00a0incision sites each containing at least one lymphatic vessel suitable for anastomosis. In every patient, we could perform 3.38\u00a0\u00b1\u00a00.62 anastomoses. Mean follow\u2010up was 12.13\u00a0\u00b1\u00a02.73\u00a0months. After surgery, mean preoperative QoL score increased from 5.5\u00a0to 7.9 (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001), and mean difference between the mean circumferences of the affected and healthy limbs decreased from 4.3\u00a0\u00b1\u00a01.3 to 2.5\u00a0\u00b1\u00a01.3\u00a0cm, showing improvement of swelling after surgery (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This technique allowed to preoperatively map UL lymphatics even if diffuse DB was present.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30247","type":"journal-article","created":{"date-parts":[[2017,9,27]],"date-time":"2017-09-27T05:56:58Z","timestamp":1506491818000},"page":"881-889","source":"Crossref","is-referenced-by-count":49,"title":["Lymphatic mapping of the upper limb with lymphedema before lymphatic supermicrosurgery by mirroring of the healthy limb"],"prefix":"10.1002","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9682-4706","authenticated-orcid":false,"given":"Stefano","family":"Gentileschi","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Fondazione Policlinico Universitario A. Gemelli Largo Agostino Gemelli 1, Rome 00168 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Servillo","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Catholic University Sacred Heart, Policlinico Agostino Gemelli Largo Agostino Gemelli 1, Rome 00168 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberta","family":"Albanese","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Catholic University Sacred Heart, Policlinico Agostino Gemelli Largo Agostino Gemelli 1, Rome 00168 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"De Bonis","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Catholic University Sacred Heart, Policlinico Agostino Gemelli Largo Agostino Gemelli 1, Rome 00168 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Girolamo","family":"Tartaglione","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine Ospedale Cristo Re Via delle Calasanziane 25, Rome 00168 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marzia","family":"Salgarello","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Catholic University Sacred Heart, Policlinico Agostino Gemelli Largo Agostino Gemelli 1, Rome 00168 Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,9,27]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181e5f6a9"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002683"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182a4d626"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.30142"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.22478"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjx031"},{"key":"e_1_2_8_8_1","first-page":"1","article-title":"The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology","volume":"46","author":"International Society of 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