Multiple injections of indocyanine green for improving the outcomes of lymphatic-venous anastomosis reconstruction of lymphatic return under microscopy: A case report.

Abstract

This study explores effective treatment methods for chronic secondary lymphedema after radical cervical cancer surgery combined with pelvic lymphadenectomy. In cases where conservative treatment was ineffective, we investigated whether multiple injections of indocyanine green can effectively improve the outcomes of lymphatic-venous anastomosis under microscopy. Preoperative lymphatic imaging was used to localize functional vessels, guiding distal left lower limb lymphatic reconstruction. Intraoperatively, supermicroscopy (40×) and real-time indocyanine green imaging enabled eight end-to-end anastomoses between 0.5- and 1.3-mm lymphatic capillaries and subcutaneous veins. Each anastomosis took ≤30 min, with intraoperative lymphangiography confirming patency. Immediate postoperative lymphatic diversion to veins was observed. By day 3, reconstructed pathway efficiency reached 83% of the healthy side, with visual analog scale pain scores decreasing from 5 to 2. At 3-6 months, mid-thigh and calf circumferences reduced progressively; ultrasound confirmed edema resolution and complete cessation of exudation. High-precision multipoint supermicrosurgical anastomosis achieved anatomical and functional reconstruction of chronic secondary lymphedema, overcoming traditional size and functional limitations. Innovations included multipoint design to prevent reobstruction and dynamic imaging-guided precision. This case establishes a radical treatment strategy for chronic secondary lymphedema.