Therapeutic, IV.

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Lymph vessel flap transplantation (LFT), lymphaticovenous anastomosis (LVA), or lymph node flap transfer are sometimes used to treat lymphedema that is resistant to conservative treatment. LFT harvested from the contralateral limb has been reported for the treatment of lymphedema. Here we report the use of modified LFT from the abdominal wall for the treatment of refractory lymphedema. Our patient was a 57-year-old patient with secondary lower limb lymphedema was previously treated with conservative therapy and lymphaticovenous anastomosis. We first examined the lymphatic function of the lower abdominal region in the patient using indocyanine green (ICG) lymphography. After confirming the good lymphatic function in the right abdominal region, we harvested the pedicled abdominal adiposal flap containing multiple abdominal lymph vessels and transferred it to the left groin region. The flap (20 × 10 cm ) was based on the superficial circumflex iliac artery perforator. We anastomosed one lymph vessel in the flap to that in the recipient site. We also performed multiple fibrotripsy using a 3-mm-diameter stainless steel stick inserted into small incisions. The postoperative course was uneventful. The circumference measurement was decreased by 2.2-13.5 cm at 1 year after the operation. The lower abdominal region has many lymph vessel networks and is thought to be a less risky donor site in patients with lymphedema than the lower limbs. Thus, LFT may be an option for the treatment of chronic lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery 36:695-699, 2016.

Background:We investigate the effectiveness of lymphaticovenous anastomosis (LVA) in releasing lymphedema-associated pain.Methods:We performed a retrospective analysis. Subjects of this study included lower extremity lymphedema patients who presented persistent and constant degrees of pain in their lower limbs. LVA was performed under local anesthesia. The preoperative lower extremity pain and postoperative lower extremity pain were surveyed using the visual analog scale on a score from 0 to 10. The circumferences of the limbs were also recorded.Results:A total of 8 patients (16 lower limbs) were included. The subjects included 1 man and 7 women, and their average age was 72 years. The average follow-up period was 17 months. The average preoperative and postoperative visual analog scale scores were 5.3 and 1.8, respectively. Moreover, 7 patients who had records of their lower extremity circumference observed an average changing rate of −4.7% in lower extremity lymphedema index after the surgery.Conclusion:LVA can release the pain in the affected limbs of lymphedema.

Sclerotic lymphatics are more predominantly found in the proximal limb whereas nonsclerotic vessels are more often found toward the distal end. These findings help lymphatic surgeon determine incision sites.

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Background Sometimes, chronic pain in the arm or chest could occur in postmastectomy patients. Although the pathology of the pain is unclear, the involvement of neurological mechanism, cicatricial contracture, or lymphedema is considered. The purpose of this study was to investigate the effectiveness of lymphaticovenous anastomosis (LVA) in reducing chronic pain in upper limb lymphedema patients. Patients and Methods This prospective study included consecutive 13 patients with upper limb lymphedema who received LVA. Preoperative lymphoscintigraphy and indocyanine green lymphography were performed. Pre-and postoperative pain scale were recorded using the visual analog scale (VAS). The number of cellulitis 1 year before and after LVA were compared. LVA was performed under local anesthesia, using a surgical microscope, and 12-0 nylon suture was used in the anastomosis. Results Two out of 13 patients were excluded from this study, and 11 patients were subjected to this study. All subjects were females with an average age of 64.3 years. The average lymphedema duration was 76.7 months. The average number of LVA sites was 5.7 per limb and the average follow-up period was 10.6 months. The average pre-and postoperative VAS scores were 3.5 and 0.59, respectively; the significant decrease was observed (p ¼ 0.017). Three of the patients who had experienced cellulitis (once, twice, and four times, respectively) did not develop any cellulitis after LVA. Conclusion LVA was shown to be an effective surgical remedy for treating the lymphedema-associated pain of upper limb after breast cancer treatment.