{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:41:27Z","timestamp":1785800487265,"version":"3.56.0"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2018,12,3]],"date-time":"2018-12-03T00:00:00Z","timestamp":1543795200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Detecting more number of functional lymphatic vessels is the essential point in lymphaticovenous anastomosis (LVA). The purpose of this prospective study was to elucidate the efficacy of multi\u2010area injection in indocyanine green (ICG) lymphography in LVA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We injected ICG into the first web spaces of the feet or the second web space of the hands, subcutaneously. In multi\u2010area injection group, we injected additional ICG in other areas. We determined the incision design of LVA on the line at about 5\u2009cm distal to dermal backflow point. In control group, we determined the incision site based on the linear pattern in ICG lymphography and lymphoscintigraphic findings. We performed LVA, and evaluated the circumference change and the intraoperative condition of the collecting lymphatic vessels based on Normal, Ectasis, Contraction, and Sclerosis Type (NECST) classification.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty patients (115 limbs) in multi\u2010injection group and 49 patients (81 limbs) in control group were included. We injected ICG into an average of 1.9 sites in multi\u2010injection group. The average number of anastomoses per limb was 3.3 in both groups. The average circumference change was \u22121.83% in multi\u2010injection group and \u22120.34% in control group (<jats:italic>P<\/jats:italic>\u2009=\u2009.021). The percentage of the Ectasis type lymphatic vessels was 59.0% in multi\u2010injection group and 40.2% in control group (<jats:italic>P<\/jats:italic>\u2009=\u20093.30\u2009\u00d7\u200910<jats:sup>\u22125<\/jats:sup>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>By injecting ICG into multiple sites in the affected limbs, we could detect a greater number of functional lymphatic vessels (Ectasis type) during LVA. This could lead to a better surgical result.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30398","type":"journal-article","created":{"date-parts":[[2018,12,3]],"date-time":"2018-12-03T17:29:46Z","timestamp":1543858186000},"page":"167-173","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":54,"title":["Multi\u2010area lymphaticovenous anastomosis with multi\u2010lymphosome injection in indocyanine green lymphography: A prospective study"],"prefix":"10.1002","volume":"39","author":[{"given":"Hisako","family":"Hara","sequence":"first","affiliation":[{"name":"Department of Lymphatic and Reconstructive Surgery Saiseikai Kawaguchi General Hospital  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Mihara","sequence":"additional","affiliation":[{"name":"Department of Lymphatic and Reconstructive Surgery Saiseikai Kawaguchi General Hospital  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,3]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cps.2012.08.002"},{"issue":"1","key":"e_1_2_6_3_1","first-page":"56","article-title":"Liposuction in lymphedema treatment","volume":"32","author":"Brorson H.","year":"2016","journal-title":"Journal of Reconstructive Microsurgery"},{"issue":"1","key":"e_1_2_6_4_1","first-page":"42","article-title":"A single\u2010site technique of multiple lymphatic\u2010venous anastomoses for the treatment of peripheral lymphedema: Long\u2010term clinical outcome","volume":"32","author":"Campisi C. 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