Cumulative Experience in Lymphovenous Anastomosis for Lymphedema Treatment: The Learning Curve Effect on the Overall Outcome

Pereira, Nicolás; Lee, Yeon Hoon; Suh, Young Chul; Choi, Donghoon; Suh, Hyun Suk; Jeon, Jae Yong; Hong, Joon Pio

doi:10.1055/s-0038-1648220

Cited by 39 publications

(59 citation statements)

References 30 publications

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“…An out-to-in transluminal suture is placed through a vein with a large diameter, followed by an in-to-out transluminal suture, which intussuscepts all the lymphatic vessels into the vein, and forms an LVA complex that resembles an octopus. 50 Per case 1 29,30,36,[51][52][53] to 18 46 anastomoses were performed, and it took an average of 3 to 4 hours 29,35,[44][45][46][54][55][56][57][58] for surgeons to perform the entire procedure. Follow-up time ranged from 1 59,60 to 87 months.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies assessed the relationship between lymphedema and episodes of cellulitis or lymphangitis. 1,24,27,29,30,34,38,56,60,61,[63][64][65] All, except one chart review by Lee et al, 63 reported significant reductions in infection incidence.…”

Section: Resultsmentioning

confidence: 99%

“…82 Constant lymphatic vessels are easier to locate at the dorsal foot, ankle, and groin region for the lower extremity. 29 However, Seki et al 83 described a method to locate easily between three to five superficial large lymphatic vessels when a 2.5-cm transverse incision is made in the intersection of a transverse line at the superior edge of the patella and a longitudinal line along the medial axis of the distal thigh. Preoperative identification of functional lymphatic vessels and veins can substantially shorten operative time this approach, Yoshida et al 54 illustrated the mechanical dilatation technique, in which a larger nylon monofilament was inserted after the IVaS to dilate the vessel lumen.…”

Section: Discussionmentioning

confidence: 99%

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Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

Forte

Khan

Huayllani

et al. 2020

Indian J Plast Surg

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Background Lymphedema is an accumulation of protein-rich fluid in the interstitial spaces resulting from impairment in the lymphatic circulation that can impair quality of life and cause considerable morbidity. Lower extremity lymphedema (LEL) has an overall incidence rate of 20%. Conservative therapies are the first step in treatment of LEL; however, they do not provide a cure because they fail to address the underlying physiologic dysfunction of the lymphatic system. Among several surgical alternatives, lymphaticovenous anastomosis (LVA) has gained popularity due to its improved outcomes and less invasive approach. This study aims to review the published literature on LVA for LEL treatment and to analyze the surgical outcomes. Methods PubMed database was used to perform a comprehensive literature review of all articles describing LVA for treatment of LEL from Novemeber 1985 to June 2019. Search terms included “lymphovenous” OR “lymphaticovenous” AND “bypass” OR “anastomosis” OR “shunt” AND “lower extremity lymphedema.” Results A total of 95 articles were identified in the initial query, out of which 58 individual articles were deemed eligible. The studies included in this review describe notable variations in surgical techniques, number of anastomoses, and supplementary interventions. All, except one study, reported positive outcomes based on limb circumference and volume changes or subjective clinical improvement. The largest reduction rate in limb circumference and volume was 63.8%. Conclusion LVA demonstrated a considerable reduction in limb volume and improvement in subjective findings of lymphedema in the majority of patients. The maintained effectiveness of this treatment modality in long-term follow-up suggests great efficacy of LVA in LEL treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

Forte

Khan

Huayllani

et al. 2020

Indian J Plast Surg

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“…Reflecting the current trend toward perforator flap or supermicrosurgery, there has been an increase interest in ultrasound use in reconstructive microsurgery, especially in supermicrosurgery cases. [30][31][32][33][34] During 2019, there were at least three lymphedema symposiums, and one supermicrosurgery symposium. In 2020, the second Ultrasound Symposium for Reconstructive Microsurgery will be held in Rome.…”

Section: Discussionmentioning

confidence: 99%

The Role of Duplex Ultrasound in Microsurgical Reconstruction: Review and Technical Considerations

Cho

Kwon

Pak

et al. 2020

J Reconstr Microsurg

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Background With the technological advances, microsurgery has evolved to the era of supermicrosurgery since its inception. With the popularization of these flaps, proficiency in using tools such as color Doppler ultrasound (CDU) has become crucial. Despite the increased interest, studies regarding the role of ultrasound in microsurgical reconstruction are scarce. Therefore, in this study, we discussed currently available imaging modalities for reconstructive surgeons, types of ultrasound, and the role of ultrasound in microsurgical reconstruction, and made recommendations for ultrasound use in reconstructive surgery. Methods We performed a computerized search of ultrasound in reconstructive surgery using the MEDLINE database. Data regarding ultrasound indications, usage, and outcomes were collected. Results Of the 115 articles identified, the majority was written on nonreconstructive ultrasound uses (51.4%). For the reconstructive uses, mapping of perforators was the most common usage (39.1%), followed by flap monitoring and volume measurement. In addition, we found that there are a limited number of literature on the role of CDU in reconstructive surgery, especially on its intraoperative and postoperative use. Conclusion CDU is a valuable and powerful tool for any reconstructive surgeons who are interested in performing microsurgery or supermicrosurgery. As the demand of customized flaps using superthin flaps, perforator-to-perforator anastomosis, and supermicrosurgery increases, understanding and becoming versatile in CDU will be critical. We hope our experience with using ultrasound and refinements that we made are helpful for those who would like to include it as a part of their armamentarium.

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“…However, a beginner when performing lymphovenous anastomosis supermicrosurgery may still show reasonable results as long as he or she abides by the principle of supermicrosurgery. As experience accumulates, one can expect better proﬁciency by decreasing anastomosis and dissection time . Special instruments, such as fine dilators, forceps, and microscissors, designed for supermicrosurgery will help to make the process smoother.…”

Section: The Principlesmentioning

confidence: 99%

Supermicrosurgery: Principles and applications

Hong

Song

Suh

2018

Journal of Surgical Oncology

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Supermicrosurgery is defined as microsurgery in less than 0.8 mm vessels. It is an evolved form of microsurgery but with the same principle: (1) enhanced working environment including microscopes and finer instruments; (2) detailed preoperative evaluation and planning; (3) supermicrosurgical technique; and (4) postoperative care.Supermicrosurgery now provides reconstructive solutions to address lymphedema, distal finger amputations, allows minimal invasive reconstruction using a perforator to perforator approach, and will eventually allow targeted customized reconstruction.application of supermicrosurgery, lymphedema, oncologic reconstruction, perforator to perforator supermicrosurgery, supermicrosurgery

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Cumulative Experience in Lymphovenous Anastomosis for Lymphedema Treatment: The Learning Curve Effect on the Overall Outcome

Cited by 39 publications

References 30 publications

Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

Lymphaticovenous Anastomosis for Lower Extremity Lymphedema: A Systematic Review

The Role of Duplex Ultrasound in Microsurgical Reconstruction: Review and Technical Considerations

Supermicrosurgery: Principles and applications

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