Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema
Article first published online: 27 APR 2009
Copyright © 2009 Wiley-Liss, Inc.
Volume 29, Issue 8, pages 609–618, November 2009
How to Cite
Demirtas, Y., Ozturk, N., Yapici, O. and Topalan, M. (2009), Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Microsurgery, 29: 609–618. doi: 10.1002/micr.20665
- Issue published online: 2 NOV 2009
- Article first published online: 27 APR 2009
- Manuscript Accepted: 23 MAR 2009
- Manuscript Received: 6 FEB 2009
Recent supermicrosurgical techniques have developed the possibility for vascular anastomosis of smaller vessels and it is now safe and sound to perform precise anastomoses between lymphatics and venules. Reported here is the 2 years experience on supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation combined with a nonoperative physical therapy for treatment of lower extremity lymphedema. Microlymphatic surgery was performed in 42 patients with unilateral lower extremity lymphedema. Thirty patients were women and 12 were men with a mean age of 34. Lymphaticovenular anastomoses were performed in 37 patients with an average of 2.5 anastomoses per patient, and lymphaticovenous implantations were made in 36 patients with an average of 2.4 implantations per patient. The lymphatics that were larger than 0.3 mm were anastomosed to venules with supermicrosurgical technique. Lymphaticovenous implantation technique was used for thinner lymphatics in a particular incision. Postoperatively, 18 patients used continuous compressive garments, 9 patients used garments but discontinued after 6 months, and no compression was used in 9 patients. The results of surgery were assessed both clinically with volume measurements and by lymphoscintigraphy and were classified as good, moderate, or ineffective. The mean decrease in the volume of the edema was 59.3% at an average follow-up of 11.8 months. Six outcomes were classified as ineffective, eight outcomes as moderate, and 28 outcomes as good. Supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation seems to be highly beneficial, especially in the early stages of peripheral lymphedema and may be offered as the treatment of choice in selected patients. © 2009 Wiley-Liss, Inc. Microsurgery 2009.