Fig 3.

(A) Reverse lymphatic mapping for lateral-thoracic wall vascularized lymph node transfer (VLNT). Patients receive preoperative lymph-scintigraphy to mark the lymph nodes draining the arm with technetium (Tc99). Additionally, indocyanine green (ICG) is injected at the lateral thoracic wall (LTW). Then, ICG-positive lymph nodes that drain the LTW (green area) are included in the (B) lymph node flap, while Tc99 positive lymph nodes (red area) are spared to preserve lymphatic drainage of the arm. (C) Preoperative photograph of a 58-year-old woman with secondary lymphedema of her left leg after pelvic lymph node dissection owing to endometrial cancer. (D) The 1-year-follow-up after LTW-VLNT to the left groin, two lymphovenous anastomoses (LVAs) at the foot and liposuction of the thigh (300 mL lipoaspirate) showed a significant volume reduction.