{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:50:52Z","timestamp":1791391852965,"version":"4.3.3"},"reference-count":8,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Summary:<\/jats:title>\n                    <jats:p>Accurate identification of functional lymphatic vessels is essential for lymphaticovenular anastomosis (LVA) but it remains challenging. Contrast-enhanced ultrasound (CEUS) is increasingly used for preoperative mapping; however, failure to detect vessels of adequate caliber often leads to deferral of LVA. We report a case where CEUS indicated no suitable lymphatic vessels intraoperatively, yet a high-quality LVA was successfully performed using preoperative indocyanine green (ICG) lymphography\u2013guided exploration. Preoperative ICG mapping revealed limited linear channels and dermal backflow, guiding targeted incisions. Intraoperatively, functional lymphatic vessels and suitable venules (0.3\u20130.4\u2009mm) were identified despite failed CEUS-guided localization, and end-to-end anastomosis was completed. Postoperatively, maximal interlimb circumference difference decreased from 2.5 to 1.7\u2009cm, with symptomatic relief. This is the first case demonstrating that when CEUS-guided intraoperative localization fails, individualized ICG findings can guide empirical incisions to identify better lymphatic vessels for LVA. A multimodal approach may improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/gox.0000000000008146","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:00:45Z","timestamp":1791388845000},"page":"e8146","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["From Failure to Flow: Indocyanine Green Improves Preoperative Mapping for Lymphaticovenular Anastomosis After Negative Contrast-enhanced Ultrasonography"],"prefix":"10.1097","volume":"14","author":[{"given":"Xinyu","family":"Lou","sequence":"first","affiliation":[{"name":"Department of Microsurgery and Lymphatic Surgery, Peking University Shenzhen Hospital, Shenzhen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnson","family":"Boey","sequence":"additional","affiliation":[{"name":"Department of Podiatry, Singhealth Polyclinic, Perth, Singapore"},{"name":"Department of Podiatric Medicine and Surgery, University of Western Australia, Perth, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longbiao","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Microsurgery and Lymphatic Surgery, Peking University Shenzhen Hospital, Shenzhen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Microsurgery and Lymphatic Surgery, Peking University Shenzhen Hospital, Shenzhen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songhua","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Microsurgery and Lymphatic Surgery, Peking University Shenzhen Hospital, Shenzhen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengzhou","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Microsurgery and Lymphatic Surgery, Peking University Shenzhen Hospital, Shenzhen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiying","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Microsurgery and Lymphatic Surgery, Peking University Shenzhen Hospital, Shenzhen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Microsurgery and Lymphatic Surgery, Peking University Shenzhen Hospital, Shenzhen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhegang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Microsurgery and Lymphatic Surgery, Peking University Shenzhen Hospital, Shenzhen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10]]},"reference":[{"key":"R1-20261007","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1002\/bjs.9588","article-title":"Lymphaticovenular anastomosis to prevent cellulitis associated with lymphoedema.","volume":"101","author":"Mihara","year":"2014","journal-title":"Br J Surg"},{"key":"R2-20261007","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.bjps.2025.10.007","article-title":"Comparative effectiveness of 24-MHz high-frequency ultrasound versus ICG for preoperative lymphatic mapping in secondary lower limb lymphedema: a retrospective study.","volume":"111","author":"Chen","year":"2025","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"R3-20261007","doi-asserted-by":"crossref","first-page":"e6922","DOI":"10.1097\/GOX.0000000000006922","article-title":"Establishing a standard method for screening lymphatic ultrasound in lymphedema patients.","volume":"13","author":"Hara","year":"2025","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"R4-20261007","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1002\/micr.30246","article-title":"Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema.","volume":"37","author":"Scaglioni","year":"2017","journal-title":"Microsurgery"},{"key":"R5-20261007","doi-asserted-by":"crossref","first-page":"5243","DOI":"10.1007\/s00330-025-12293-7","article-title":"High-frequency ultrasound combined with microbubbles for preoperative lymphatic mapping for lymphedema with a non-linear pattern in indocyanine green lymphography.","volume":"36","author":"Yuan","year":"2026","journal-title":"Eur Radiol"},{"key":"R6-20261007","doi-asserted-by":"crossref","first-page":"102361","DOI":"10.1016\/j.jvsv.2025.102361","article-title":"Contrast-enhanced ultrasound combined with ultra-high-frequency ultrasound improves preoperative planning for lymphovenous anastomosis: a pilot study.","volume":"14","author":"Tang","year":"2026","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"key":"R7-20261007","first-page":"320","article-title":"Pitfalls of the Doppler examination for venous thrombosis.","volume":"49","author":"Bendick","year":"1983","journal-title":"Am Surg"},{"key":"R8-20261007","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1038\/s41598-025-30578-1","article-title":"Application of contrast-enhanced ultrasound combined with ultra-high-frequency ultrasound in lymphaticovenous anastomosis.","volume":"16","author":"Huang","year":"2025","journal-title":"Sci Rep"}],"container-title":["Plastic and Reconstructive Surgery - Global Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/GOX.0000000000008146","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:00:46Z","timestamp":1791388846000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/GOX.0000000000008146"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":8,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/gox.0000000000008146","relation":{},"ISSN":["2169-7574","2169-7574"],"issn-type":[{"value":"2169-7574","type":"electronic"},{"value":"2169-7574","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-04-05","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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