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Page 4 of 8 Hosomi et al. Plast Aesthet Res 2023;10:60 https://dx.doi.org/10.20517/2347-9264.2023.77

Table 1. The size of upper extremities and the UEL index
Preope 1 month 6 months 18 months 24 months
Right (affected side)
above 5 cm 28 28 29 30 29
elbow 26 27.5 27 28.2 27.5
below 5 cm 25 25 26.5 26.5 27
wrist 18 18 18 18 17
the dorsum of the hand 22 21 21 21 22.5
UEL index 141.1219512 138.2193396 139.3233945 135.7291845 133.9699571
Left (unaffected side)
above 5 cm 26 26.5 26.5 29 28.5
elbow 24 24 25 25.6 25.5
below 5 cm 23 21.5 24 23.5 22.5
wrist 17 16.5 17 17.5 17
the dorsum of the hand 20 20 20.5 19.5 20
UEL index 112.2727273 114.8928571 118.75 117.3866953 114.0665236
BMI 20.5 21.2 21.8 23.3 23.3
UEL index was calculated by a summation of squares of limb circumferences (cm) at five points (the elbow, five cm above and below the elbow,
the wrist, and the dorsum of the hand) divided by body mass index. Postoperative UEL index was gradually improved. UEL: upper extremity
lymphedema.

Figure 1. Preoperative and postoperative lymphedema of the upper extremity. Postoperative recovery was uneventful. On review at 18
months postoperative, her right arm UEL index reduced by 5 from 141 before surgery to 136 after surgery. UEL: upper extremity
lymphedema.

Figure 2. Lymphatic flow in the flap detected by ICG lymphography. ICG lymphography showed the flow of lymphatic vessel and the
location of lymphatic node at the donor site. A single lymph node supplied by the proximal SCIA was identified. ICG: indocyanine green;
SCIA: superficial circumflex iliac artery.