Page 39 - Read Online

Hara et al. Plast Aesthet Res 2023;10:42 Plastic and
DOI: 10.20517/2347-9264.2023.11
Aesthetic Research

Technical Note Open Access

Lymphatic ultrasound (D-CUPS) and multi-point ICG
lymphography for successful LVA

Hisako Hara, Makoto Mihara

Department of Lymphatic and Reconstructive Surgery, JR Tokyo General Hospital, Tokyo 151-8528, Japan.
Correspondence to: Dr. Hisako Hara, Department of Lymphatic and Reconstructive Surgery, JR Tokyo General Hospital, 2-1-3
Yoyogi, Shibuya-ku, Tokyo 151-8528, Japan. E-mail: hisakohara.prs@gmail.com

How to cite this article: Hara H, Mihara M. Lymphatic ultrasound (D-CUPS) and multi-point ICG lymphography for successful
LVA. Plast Aesthet Res 2023;10:42. https://dx.doi.org/10.20517/2347-9264.2023.11

Received: 7 Feb 2023 First Decision: 25 Jul 2023 Revised: 28 Jul 2023 Accepted: 8 Aug 2023 Published: 15 Aug 2023

Academic Editors: Nicole Lindenblatt, Tine Engberg Damsgaard Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Securing dilated lymphatic vessels with good function is challenging when performing lymphaticovenous
anastomosis (LVA). To achieve this, we propose multi-point indocyanine green (ICG) lymphography and lymphatic
ultrasound (D-CUPS; Doppler, Cross, Uncollapsible, Parallel, and Superficial fascia). With multi-point ICG
lymphography, more lymphatic vessels can be found than with conventional ICG lymphography, which leads to
better surgical results. Lymphatic ultrasound is more useful because it allows the observation of cross-sections of
lymphatic vessels. It is known that lymphatic degeneration occurs in the lymphatic vessels in lymphedematous
limbs, and LVA is most effective when dilated lymphatic vessels are anastomosed. The degree of lymphatic
degeneration can be diagnosed with lymphatic ultrasound, and the proximity of dilated lymphatic vessels and veins
suitable for anastomosis can be reliably identified and selected as the skin incision site for LVA. Lymphatic
ultrasound is a safe, versatile and useful imaging technique that does not require a contrast agent and can be
performed by anyone. By mastering multi-point ICG lymphography and lymphatic ultrasound (D-CUPS), the
operation time can be shortened, and more effective LVA can be performed. In this Technical Note article, we
comprehensively describe lymphatic function examinations that we have developed so far.

Keywords: Lymphedema, indocyanine green, ICG, lymphatic ultrasound, ultrasound, lymphosome, D-CUPS

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.parjournal.net