{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T19:41:43Z","timestamp":1789933303837,"version":"4.0.1"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014869","name":"Chongqing Xinqiao Hospital, Second Affiliated Hospital of Army Medical University","doi-asserted-by":"publisher","award":["BYKYKY2024030"],"award-info":[{"award-number":["BYKYKY2024030"]}],"id":[{"id":"10.13039\/501100014869","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010037","name":"Chongqing Municipal Youth Science and Technology Talent Training Project","doi-asserted-by":"publisher","award":["No. BSKJ2024045"],"award-info":[{"award-number":["No. BSKJ2024045"]}],"id":[{"id":"10.13039\/501100010037","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This study evaluated percutaneous lymphatic contrast-enhanced ultrasound (CEUS) for preoperative localization in preparation for lymphovenous anastomosis (LVA) microsurgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Fourteen healthy volunteers and 14 patients with lower limb lymphoedema were studied. SonoVue\u00ae (Bracco, Milan, Italy) was used to measure lymphatic vessel diameters and depths in the dorsal foot, ankle, and lower leg of the subjects. In the lymphoedema patients, lymphatic vessels were observed for continuity, distortion, dilation, interruption, and other abnormalities. On the basis of the CEUS images, the lower limb lymphatic vessels were categorized as normal, dilated, contracted, or sclerotic. In the lymphoedema patients, the locations of lymphatic vessels with good visibility were marked on the skin, and the accuracy of preoperative localization was evaluated based on the basis of surgical results. The data were analysed using IBM SPSS Statistics27.0 (IBM Corp., Armonk, NY, USA). Continuous data are expressed as the means\u2009\u00b1\u2009standard deviations and were compared using paired t-tests, with <jats:italic><jats:italic>P<\/jats:italic><\/jats:italic>\u2009&lt;\u20090.05 considered statistically significant.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among the healthy volunteers, one had a 1\u20132\u2009mm lymphatic vessel visible in the dorsal foot, whereas 13 had no lymphatic vessels visible in the dorsal foot; however, lymphatic vessels were visible in the ankle and lower leg in all volunteers, with an average diameter of 0.42\u2009\u00b1\u20090.09\u2009mm, resulting in a 100% visualization success rate. In lymphoedema patients, CEUS achieved a 92.86% success rate (13\/14) in visualizing lymphatic vessels within 1 minute in lymphedema patients, excluding one patient with primary lymphoedema; the average vessel diameter was 0.66\u2009\u00b1\u20090.24\u2009mm. The most common type consisted of dilated lymphatic vessels with tortuous morphology and increased diameter, often accompanied by reflux and interstitial dispersion in lymphoedema patients. With the successful intraoperative identification of lymphatic vessels under the surface marking during LVA as the standard, the accuracy of preoperative lymphatic vessel localization by CEUS was 92.36%.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>CEUS can accurately localize functional lymphatic vessels and serves as a valuable complementary method to indocyanine green for preoperative lymphatic vessel mapping in LVA.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0330773","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T17:42:37Z","timestamp":1755884557000},"page":"e0330773","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Application of percutaneous lymphatic contrast-enhanced ultrasound in lymphovenous anastomosis microsurgery"],"prefix":"10.1371","volume":"20","author":[{"given":"Jing","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming Xing","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7393-6577","authenticated-orcid":true,"given":"Xu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"issue":"4","key":"pone.0330773.ref001","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1089\/lrb.2022.0054","article-title":"Usefulness of 33\u2009MHz Linear Probe in Lymphatic Ultrasound for Lymphedema Patients","volume":"21","author":"H Hara","year":"2023","journal-title":"Lymphat 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Lymphedema","volume":"76","author":"T Yamamoto","year":"2016","journal-title":"Ann Plast Surg"},{"issue":"5","key":"pone.0330773.ref005","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1016\/j.eururo.2010.11.020","article-title":"Assessment and follow-up of patency after lymphovenous microsurgery for treatment of secondary lymphedema in external male genital organs","volume":"60","author":"SM Mukenge","year":"2011","journal-title":"Eur Urol"},{"key":"pone.0330773.ref006","doi-asserted-by":"crossref","first-page":"100595","DOI":"10.1016\/j.conctc.2020.100595","article-title":"HAMAMATSU-ICG study: Protocol for a phase III, multicentre, single-arm study to assess the usefulness of indocyanine green fluorescent lymphography in assessing secondary lymphoedema","volume":"19","author":"S Akita","year":"2020","journal-title":"Contemp Clin Trials 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