gms | German Medical Science

Objectives/Interrogation: Lymphaticovenular anastomosis (LVA) can reduce compression therapy, the incidence of cellulitis and end with a mild infection. However, there are cases in which progression after LVA in the long term and cases where exacerbation can not be suppressed in severe cases. Since 2004, we have been attempting to transfer of lymphatic vessels with reflux function from normal parts with vascular pedicle and simultaneous multiple LVA (combined surgical treatment) on affected limbs. In this report, the progress so far will be presented.

Methods: We have performed LVA for about 300 upper limb lymphedema since 1990, but we undertook joint surgical treatment for 14 cases of severe (LVA ineffective) upper limb edema after 2013. The breakdown was 46 to 76 (average 61.4) years old, male 1, female 13 cases, right 6, left 8 cases. Edema progressed or unchanged despite compression therapy and LVA before and after surgery between 2 months and 20 years after edema occurred. Radiotherapy 8 cases, cellulitis 4 cases occurred. Combined surgical treatment was done from 4 months to 5 years and 3 months after the initial LVA. The donors of the flaps were taken from the first web space with the first dorsal metatarsal artery perforator (4 cases). Alternatively, lymphatic channels with SCIP were collected from the groin (11 cases), and divided into 1-2 (5 cases) pieces, transplanted into single or multiple parts in the arm, and vascular anastomosis (& LVA) was performed.

Results and Conclusions: In 13 cases, postoperative follow-up observation was possible. The period was from 2 months to 3 years 2 months (average 11.3 months). The results after surgery at the present time were: compression unnecessary 1, improvement 11, invariant 1, exacerbation 1 case.

From the searches so far, there are individual differences in the effect of LVA, and it is presumed that degeneration / regeneration of smooth muscle cells within lymph vessel affect the postoperative course. Combined surgical treatment using LVA and functional lymphatics transfer requires supermicrosurgical dissection of the lymphatic system, but severe cases of upper and lower limbs where improvement could not be obtained with LVA seems to be indicated. In cases where postoperative compression became unnecessary, we believe that functional recovery of the transplanted lymphatic channels is occurring.