Fig. 5.

A, The patient shown here is a 71-year-old woman who had suffered left LEL for 9 years following hysterectomy. Preoperative ICG lymphography revealed stage 2 leg dermal backflow. No dermal backflow was observed around the ankle. The preoperative left LEL index was 277.7. B, A single LVA was created by means of the superior-edge-of-the-knee incision method. At 16 months, her right LEL index was reduced to 254.3. Although the lymphedema was improved at the groin, thigh, and lower leg, new lymphedematous swelling occurred around the ankle after the patient suffered a fall. Upon postoperative ICG lymphography, the stardust pattern in the thigh region had lessened, but a new stardust pattern emerged from the ankle to the lower leg. Additional LVAs were created around the ankle 16 months after the single LVA, and the edema around the ankle improved considerably. C, At 24 months after the single LVA, the LEL index was 254.1, and the edema around the ankle had improved considerably, like that at other regions. Postoperative ICG lymphography at 24 months showed reduction of stardust pattern around the thigh due to application of the superior-edge-of-the-knee incision method and around the ankle due to the creation of additional LVAs there.