Prophylactic lymphaticovenous anastomosis (LVA) for preventing lymphedema after sarcoma resection in the lower limb: A report of three cases and literature review

Abstract

Patients with soft tissue tumors of the lower extremities are at greater risk to develop postoperative disruption of lymphatic vessels. Currently, there is no widely effective cure for lymphatic dysfunction. Therefore, the best strategy is to prevent it and reconstruct efficient drainage as soon as the original pathway is damaged. We present a report of three prophylactic LVA cases after sarcoma resection in the lower limb, and a literature review to show the feasibility of prophylactic LVAs. The patients were 35, 73, and 77 years old, respectively, at the time of the procedure. All three patients had sarcoma in the medial thigh and underwent radiation therapy before the surgery. The locations of the LVAs include the medial thigh and medial and lateral calf. During the surgery, methylene blue and/or indocyanine green were injected to identify lymphatic vessels. Postoperative recovery was uneventful immediately after the surgery. At follow‐up visits, all three patients reported improved functions with no significant swelling in the lower limb. One patient experienced a surgical wound infection that resolved after antibiotic admission. Two patients had a history of cardiac diseases, a major risk factor for developing postoperative lymphedema, but these two patients did not develop lymphedema with the treatment of prophylactic LVAs. These results suggest that prophylactic LVA may be an effective strategy to prevent secondary lymphedema after sarcoma resection. Further investigation is warranted.

Interdisciplinary Surgical Therapy of Extremity Soft-Tissue Sarcomas: A Personalized Resection and Reconstruction Algorithm

“…Therefore, besides defect reconstruction, surgeons should consider lymphatic restauration as well, to provide sufficient lymph drainage and to prevent lymphatic complications. The most used procedure is lymphatic restauration with prophylactic lymphaticovenous anastomoses (LVA) at the time of reconstructive surgery [ 33 ]. However, other strategies have been proposed lately.…”

“…However, other strategies have been proposed lately. The usage of lymph-interpositional-flap transfer (LIFT) or lymphatic flow-through flaps (LyFT) is gaining popularity [ 33 , 34 , 35 , 36 ]. Lymphatic interpositional flaps preserve the lymphatic system from the donor to recipient site, where neolymphangiogenesis regenerates lymphatic drainage [ 34 ].…”

Immediate‐delayed lymphatic reconstruction after axillary lymph nodes dissection for locally advanced breast cancer‐related lymphedema prevention: Report of two cases

“…ILR is commonly performed for BCRL primary prevention, which is known as Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) (boccardo 1,2,3,4). Several studies have also applied ILR for primary lymphedema prevention in the lower extremity (Ezawa et al, 2019; Wagner et al, 2022; Wan et al, 2022). However, the surgical concept can also be served for secondary prevention.…”

Editorial for the Special Issue “Vasorum Lymphaticorum: From the Discovery of the Lymphatic System to the New Perspectives in Microsurgical Reconstruction and Patient Rehabilitation”

“…Prophylactic treatment for lymphedema prevention has been also suggested in sarcoma resections. Wan et al [25] suggest performing LVA procedures after resections of sarcomas of the lower limb at the level of the medial thigh and medial and lateral calf.…”