{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T13:57:35Z","timestamp":1780667855312,"version":"3.54.1"},"reference-count":30,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2019,11,8]],"date-time":"2019-11-08T00:00:00Z","timestamp":1573171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Manual Lymphatic Drainage (MLD) appears to stimulate lymphatic contraction, aid in the development of secondary derivation pathways, and stimulate the appearance of collateral pathways that could function as the main drainage routes of the limb in case of lymphedema. Through stretching, call up maneuvers are used to stimulate lymphangion reflex contraction and, therefore, lymphatic function. The aim was to describe the presence of areas and pathways of collateral lymphatic drainage under basal conditions and to determine, using Indocyanine Green (ICG) lymphography, whether an increase in these pathways occurs after 30 min of manual lymphatic stimulation with only call up maneuvers according to the Leduc Method\u00ae\u00ae. In this prospective analytical study (pretest\u2013posttest), the frequency of presentation of areas and collateral lymphatic pathways was analyzed in 19 patients with secondary lymphedema of the upper limb after breast cancer using an infrared camera. Analyses were completed at three time points: after ICG injection, at baseline (pretest), and after the application of MLD (post-test). The Leduc Method maneuvers were applied to the supraclavicular and axillary nodes, chest, back, Mascagni, and Caplan pathways. The areas visualized in the pretest continued to be visible in the posttest. Additional pathways and fluorescent areas were observed after the maneuvers. The McNemar test showed statistical significance (p = 0.008), the odds ratio was infinite, and the Cohen\u2019s g value was equal to 0.5. Manual stimulation by call up maneuvers increased the observation frequency of areas and collateral lymphatic pathways. Therefore, ICG lymphography appears to be a useful tool for bringing out the routes of collateral bypass in secondary lymphoedema after cancer treatment.<\/jats:p>","DOI":"10.3390\/jcm8111917","type":"journal-article","created":{"date-parts":[[2019,11,8]],"date-time":"2019-11-08T11:30:19Z","timestamp":1573212619000},"page":"1917","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Visualization of Accessory Lymphatic Pathways, before and after Manual Drainage, in Secondary Upper Limb Lymphedema Using Indocyanine Green Lymphography"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8230-4491","authenticated-orcid":false,"given":"Mar\u00eda Elena","family":"Medina-Rodr\u00edguez","sequence":"first","affiliation":[{"name":"General Hospital of Gran Canaria Dr. Negrin, Barranco de la Ballena, s\/n. 35010 Las Palmas de Gran Canaria, Spain"},{"name":"Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria Las Palmas, Calle Juan de Quesada, s\/n, 35001 Las Palmas de Gran Canaria, Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3545-3208","authenticated-orcid":false,"given":"Mar\u00eda","family":"de-la-Casa-Almeida","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, University of Seville, C\/Avicena s\/n. 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efr\u00e9n","family":"Martel-Almeida","sequence":"additional","affiliation":[{"name":"General Hospital of Gran Canaria Dr. Negrin, Barranco de la Ballena, s\/n. 35010 Las Palmas de Gran Canaria, Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arminda","family":"Ojeda-C\u00e1rdenes","sequence":"additional","affiliation":[{"name":"General Hospital of Gran Canaria Dr. Negrin, Barranco de la Ballena, s\/n. 35010 Las Palmas de Gran Canaria, Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther M.","family":"Medrano-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, University of Seville, C\/Avicena s\/n. 41009 Seville, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,11,8]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Massage and damage to lymphaties","volume":"28","year":"1995","journal-title":"Lymphology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.physio.2010.08.003","article-title":"Postmastectomy lymphoedema: Different patterns of fluid distribution visualised by ultrasound imaging compared with magnetic resonance imaging","volume":"97","author":"Tassenoy","year":"2011","journal-title":"Physiotherapy"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/S0031-9406(05)66126-3","article-title":"A study of lymphoedema patients over their first six months of treatment","volume":"85","author":"Todd","year":"1999","journal-title":"Physiotherapy"},{"key":"ref_4","unstructured":"Arias, A., and Alvarez, M.J. 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