Lymphatic Mapping and Preservation: Strategies to Reduce Lymphatic Damage and Its Consequences in Lower Limb Surgery

Background: In the modern resurgence of reconstructive lymphatic surgery, the prevention of lymphatic damage often receives insufficient attention. Various scenarios in oncological, traumatic, reconstructive, and aesthetic plastic surgery offer opportunities to prevent lymphatic injury and its potential clinical consequences. This article presented the cumulative case series we have gathered to date, in which lymphatic vessels were mapped with a preventive intent—an approach we referred to as lymphatic mapping and preservation. Methods: Lymphatic mapping with preventive intent was performed either indirectly using ultrasound (mapping the great saphenous vein and its branches) and/ or directly using indocyanine green lymphography. Postoperatively, the presence, absence, and severity of lymphedema were assessed clinically, whereas the integrity and patency of the great saphenous vein were evaluated via ultrasound. Results: Twelve cases of soft-tissue tumors of the medial thigh, 3 cases of traumatic wounds, and 6 cases involving flap planning were included. In all patients—except 4—it was possible to preserve the great saphenous vein and, presumably, a significant portion of the surrounding perisaphenous lymphatic tissue. Stage I or II lymphedema was observed in 6 patients (5 following soft-tissue tumor resection and 1 due to trauma). Conclusions: Preservation of the great saphenous vein and the adjacent perisaphenous lymphatic-adipose tissue may help reduce iatrogenic damage to lymphatic collectors and the associated clinical manifestations. Lymphatic mapping and preservation is a straightforward approach that can be applied across multiple surgical scenarios and specialties