Deep, single lymphovenous anastomosis at the level of the medial knee for stage 1 lymphedema

This is a patient with a very early onset of stage 1 lymphedema. An ICG scan on the day before surgery showed mostly intact lymphatics. However, when the scan was repeated immediately before surgery, some dermal backflow was detected in the proximal thigh. It was decided to make the incision at the level of the medial knee. Only one small, very deep lymphatic vessel was visible, which made establishing the anastomosis challenging. It was revised several times until it was patent.