Peta Tehan and Neil Piller

Peta Tehan is Lecturer in the Master of Wound Care,Department of Surgery, School of Clinical Sciences, Monash University, Victoria, Australia; Neil Piller is Director, Lymphoedema Clinical Research Unit, Department of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, Australia

Amanda Pigott, Hiroo Suami, Andrew McCann and Megan Trevethan

Abstract

      Head and neck lymphoedema occurs frequently after head and neck cancer treatment and causes physical and psychosocial disability. Imaging is not routinely used to diagnose or inform its conservative treatment. Indocyanine green (ICG) lymphography is used for these purposes in upper and lower limb lymphoedema.

Aim: The study aimed to explore the clinical potential of ICG lymphography in diagnosis and conservative management of head and neck lymphoedema.

Methods: Participants underwent a single examination with ICG lymphography. The tracer injection sites were determined by anatomic lymphatic territories. Presence of dermal backflow was used to diagnose lymphoedema. Imaging data were recorded using a bespoke audit tool to document lymphatic movement features and manual lymphatic drainage observations.

Results: Six participants underwent head and neck ICG lymphography. Lymphatic vessels and dermal backflow were visualised in all participants. Manual lymphatic drainage observations suggested all participants required very firm pressure to move the ICG dye through areas of dermal backflow, whereas only light pressure was required in areas with linear lymphatic vessel flow.

Conclusion: ICG lymphography can identify lymphatic structures and drainage patterns in the head and neck region and is considered a potential tool for diagnosis and conservative treatment planning for head and neck lymphoedema.

Key words：Head and neck cancer, lymphoedema, indocyanine green, fluorescence imaging

      Amanda Pigott is Clinical Specialist, Department of Occupational Therapy, Princess Alexandra Hospital, Brisbane; and Honorary Research Fellow, University of Queensland, Brisbane, Australia. Hiroo Suami is Associate Professor, Australian Lymphoedema Education, Research and Treatment (ALERT) Program, Department of Human Sciences, Macquarie University, Sydney, Australia. Andrew McCann is Director, Department of Vascular Medicine, Princess Alexandra Hospital, Brisbane, Australia. Megan Trevethan is Clinical Specialist, Department of Occupational Therapy, Princess Alexandra Hospital, Brisbane; and PhD candidate, University of Queensland, Brisbane, Australia. Declaration of interest: None.

      Acknowledgments: The authors acknowledge the participants who donated their time for this research.

      Data availability: Contact corresponding author (该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。) to discuss.

      Funding : This work was supported by a grant from the PA Research Foundation 2019 Research Awards.

      The article highlights the major challenge of limb amputation in the Caribbean and its effects on the patient’s quality of life, stressors on the family and the burden on the healthcare system. Four clinical cases are presented with various wound aetiologies and comorbidities; these patients were candidates for limb amputation. A reassessment of the traditional wound management approach paradigmatically shifted to a new strategy. This strategy includes clinically effective, easy-to-apply, and affordable products that help to reduce limb amputation, resulting in limb salvage.

Authors:

Larry G. Baratta and Yvonne Braithwaite Superville

Larry G. Baratta is International Medical Director, Chief Medical Officer - World Wide Wound Care, LLC;

Yvonne Braithwaite is Chief Executive Officer - Rovon Foot and Wound Care Clinic

      The article highlights the major challenge of limb amputation in the Caribbean and its effects on the patient’s quality of life, stressors on the family and the burden on the healthcare system. Four clinical cases are presented with various wound aetiologies and comorbidities; these patients were candidates for limb amputation. A reassessment of the traditional wound management approach paradigmatically shifted to a new strategy. This strategy includes clinically effective, easy-to-apply, and affordable products that help to reduce limb amputation, resulting in limb salvage.

Authors:

Larry G. Baratta and Yvonne Braithwaite Superville

Larry G. Baratta is International Medical Director, Chief Medical Officer - World Wide Wound Care, LLC;

Yvonne Braithwaite is Chief Executive Officer - Rovon Foot and Wound Care Clinic