Supermicrosurgical Lymphaticovenular Anastomosis for the Treatment of Lymphedema in the Upper Extremities

Abstract

Over the last eight years, the authors analyzed obstructive lymphedema of a unilateral upper extremity in a total of 27 females, comparing the use of supramicrosurgical lymphaticovenule anastomoses and/or conservative treatment. The most common cause of edema was mastectomy, with or without subsequent radiation therapy for breast cancer. As an objective assessment of the extent of edema, the circumferences of the affected and opposite normal forearms were measured at 10 cm below the olecranon of the arm. Twelve of these patients received continual bandaging. In these patients, the average excess circumference of the affected arm was 6.4 cm over that of the normal forearm; the average duration of edema before treatment was 3.5 years; the average period for conservative treatment was 10.6 months; and the average decrease in circumference was 0.8 cm (11.7 percent of the preoperative excess). Twelve patients underwent surgery and postoperative continual bandaging. In these patients, the average excess circumference was 8.9 cm; the average duration of edema before surgery was 8.2 years; the average follow-up after surgery was 2.2 years; and the average decrease in circumference was 4.1 cm (47.3 percent of the preoperative excess). These results indicated that supermicrolymphaticovenular anastomoses with postoperative bandaging have a valuable place in the treatment of obstructive lymphedema.

Lymphedema: From diagnosis to treatment

“…Fluorescence is used to help identify the lymphatic system and an operating microscope is used to assist in microsurgery (41). Single or multiple LVA's have been reported by different authors using differing surgical sites (39,(42)(43)(44). Supermicrosurgery (anastomosis less than 0.8 mm vessels) is used in this technique, in which lymphatic vessels and adjacent venules are anastomosed, mostly in an end-to-end fashion (39,43) (Figure 5).…”

“…Single or multiple LVA's have been reported by different authors using differing surgical sites (39,(42)(43)(44). Supermicrosurgery (anastomosis less than 0.8 mm vessels) is used in this technique, in which lymphatic vessels and adjacent venules are anastomosed, mostly in an end-to-end fashion (39,43) (Figure 5). Variations on the configuration of anastomosis type were described in several studies with variable success rates (45,46).…”

“…Studies have reported improvement in patients both subjectively and objectively. In general, LVA's have been shown to be a safe technique for the management of LE (39,43).…”

Arm Lymphedema as a Consequence of Breast Cancer Therapy

“…Their overall goal is to bring lymph vessels into congested areas for better removal of excess interstitial fluid (Fazhi et al, 2009;Slavin et al, 1999) Microsurgical and supramicrosurgical treatments, similarly aim at draining excess lymphatic fluid by means of shuttling lymph vessels to more congested areas. Although no long-term studies have been conducted on the effectiveness of this surgery, there have been limb volume reductions and successful connections of lymph vessels and veins, lymph nodes and veins, and multiple lymph vessels (Weiss et al, 2003 ;Becker et al, 2006;Baumeister, 2003aBaumeister, , 2003bKoshima, 2000;Chang, 2010;Campisi et al, 2006). Surgical treatment of affected lymphedema sights is risky and very rarely a necessary consideration.…”

Recent Advancement on Surgical Treatments for Lymphedema

“…1,2) Nevertheless, a surgical technique to treat very small vessels has recently been established (super-microsurgery: anastomosis of vessels 0.8-0.5 mm in diameter) in the field of plastic and reconstructive surgery, making anastomosis of extremely small blood vessels possible. [3][4][5][6] Using this microscopic anastomosis technique, a new method for lymphaticovenular anastomosis with outcomes exceeding those of conventional gross lymphaticovenous drainage 1,2,7) or lymphaticovenous anastomosis [8][9][10] has been developed. Presently, cases showing marked alleviation of severe edema over 10 years or more after surgery are beginning to be reported.…”