Surgical Strategy for Intractable Inguinal Lymphorrhea Using Combined Indocyanine Green Imaging and Negative Pressure Wound Therapy.

Refractory inguinal lymphatic leakage following groin surgery remains a challenging complication, often resulting in prolonged wound healing, infection, or femoral artery rupture. We established a reliable and minimally invasive strategy combining indocyanine green (ICG) fluorescence imaging with negative pressure wound therapy (NPWT) to identify and manage persistent lymphatic leakage. Four patients with refractory inguinal lymphatic leakage unresponsive to prior ligation received treatment between 2021 and 2024. ICG was administered subcutaneously at 4 sites on the foot to visualize lymphatic pathways using near-infrared imaging. Intraoperative ICG fluorescence enabled precise identification, ligation, and cauterization of leaking lymphatic vessels. NPWT (-75 to -125 mm Hg) was applied immediately postoperatively until wound contraction was observed. All patients (mean age = 69.5 ± 14.7 y, all male) achieved complete healing. The mean duration of NPWT and epithelialization was 18 ± 4.5 and 48 ± 14.0 days, respectively. No recurrence or complications occurred. This approach allowed closure of lymphatic leaks that had persisted despite conventional surgical management. In conclusion, combining ICG-guided lymphatic mapping and NPWT provides a practical, minimally invasive, and reproducible strategy for treating refractory inguinal lymphatic leakage. This technique enables reliable identification of responsible lymphatic vessels and promotes wound healing through continuous drainage and compression, representing an innovative option for complex postoperative lymphatic complications.