{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T06:20:49Z","timestamp":1773296449350,"version":"3.50.1"},"reference-count":0,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J reconstr Microsurg"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Investigating correlations between clinical, instrumental, and genetic features of primary lymphedema (PL) with the aim to facilitate the diagnosis, the staging, and the management of this subgroup of patients.<\/jats:p><jats:p>\n          Methods\u2003A prospective observational study was conducted from September 2016 to May 2018, including patients with diagnosis of nonsyndromic PL. All patients underwent a lymphoscintigraphic rest-stress test, an indocyanine green (ICG) lymphographic test, and a genetic test from sputum sample.<\/jats:p><jats:p>\n          Results\u2003A total of 20 patients were enrolled in the study and 44 limbs were examined. The totality of clinically affected limbs (32\/44) showed lymphographic and lymphoscintigraphic abnormalities. Concerning clinically healthy limbs (12\/44), an abnormal pattern was demonstrated in 33.3% of ICG lymphographic test and 75% of lymphoscintigraphy. Regarding lymphography findings, the most frequent pattern was the distal dermal backflow (DDB). We distinguished four grades of DDB, which correlates with clinical and lymphoscintigraphic features. Furthermore, we found a new lymphographic alteration consisting of fluorescence appearing distally to the injection site of ICG, including fingers\/toes and palmar\/plantar surface of the hand and of the foot. This alteration, called \u201cprint sign,\u201d seems to be typical of DDB pattern PL. Genetic test did not help us make any etiological diagnosis.<\/jats:p><jats:p>\n          Conclusion\u2003To our knowledge, this is the first study about PL comparing clinical, ICG lymphographic, lymphoscintigraphic, and genetic findings. As expected, all clinically affected limbs showed abnormalities in ICG lymphographic and lymphoscintigraphic tests. In opposition to what has previously been reported, also clinically healthy limbs showed lymphographic and lymphoscintigraphic alterations and this could suggest the existence of a subclinical form of PL. We proposed a grading of the DDB pattern, which correlates with clinical and lymphoscintigraphic features. Furthermore, we have described a new lymphographic alteration that seems to be typical of DDB pattern PL, the \u201cprint sign.\u201d<\/jats:p>","DOI":"10.1055\/s-0039-1698748","type":"journal-article","created":{"date-parts":[[2019,10,25]],"date-time":"2019-10-25T23:32:28Z","timestamp":1572046348000},"page":"157-164","source":"Crossref","is-referenced-by-count":4,"title":["Indocyanine Green Lymphography, Lymphoscintigraphy, and Genetic Analysis in Nonsyndromic Primary Lymphedema: The Distal Dermal Backflow Grading System and the Print Sign"],"prefix":"10.1055","volume":"36","author":[{"given":"Maria Lucia","family":"Mangialardi","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerio","family":"Lorenzano","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Domenico","family":"Pagliara","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Visconti","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Gentileschi","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanit\u00e0 Pubblica, Unit\u00e0 di Chirurgia Plastica, Rome, Italy"},{"name":"Universit\u00e0 Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marzia","family":"Salgarello","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanit\u00e0 Pubblica, Unit\u00e0 di Chirurgia Plastica, Rome, Italy"},{"name":"Universit\u00e0 Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2019,10,25]]},"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0039-1698748.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,2,24]],"date-time":"2020-02-24T23:33:45Z","timestamp":1582587225000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0039-1698748"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,25]]},"references-count":0,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2020,2,24]]},"published-print":{"date-parts":[[2020,3]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0039-1698748","relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,25]]}}}