Prevention of lymphatic injuries with lymphatic mapping: the combined technique.

We read with great interest the letter on lymph preserving lipectomy by Yamamoto and colleagues (2015)1 using indocyanine green fluorescence (ICG) to allow preservation of the lymphatic pathways during the procedure. This is an area that we consider to be fundamental in current practice for plastic surgeons, particularly for surgical sites in regions close to the main lymphatic trunks such as the axilla and inguinal region. The propensity for lymphatic injury is probably much greater than realized, given that lymphatic drainage problems can be evident on lymphoscintigraphy/microlymphography in an apparently ‘normal’ limb indicating a pre-existing vulnerability without clinical signs.2