Utility of indocyanine green fluorescence lymphography in identifying the source of persistent groin lymphorrhea

Surgical manipulation of the groin can lead to persistent lymphorrhea or lymphoceles with a reported incidence of 1.8%–18.9%.1 The wound complications associated with such leaks lymphatic leak can lead to prolonged hospital stays, additional operations, and increased healthcare costs for the patient and society.2 Initial management with pressure dressings and immobilization can progress to include aspiration, drain placement, sclerosant, radiotherapy, negative pressure wound therapy, lymphovenous anastomosis, surgical tissue transfer, and exploration with lymphatic ligation.2–5 Up to half of all patients with lymphatic leak develop an associated infection which can be catastrophic in the setting of a vascular graft.4 Vital dyes, such as isosulfan blue (Lymphazurin, Tyco Healthcare, Norwalk, Conn.), are commonly used for intraoperative identification of lymphatic leaks, thereby reducing time to resolution, complications, and need for reoperation.6 Indocyanine green (ICG) imaging is an emerging modality for lymphatic vessel visualization. We report the utility of laser-assisted ICG lymphography for intraoperative identification of lymphatic leaks presenting after surgical groin manipulation.