Lymphatico Venular Anastomosis for Treatment of Lymphorrhea

Role of Lymphatico Venular Anastomosis for Treatment of Lymphorrhea in Lower Limbs:



Publication date: Available online 18 February 2020

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Shuhei Yoshida, Yuichi Hamada, Isao Koshima, Hirofumi Imai, Toshio Uchiki, Ayano Sasaki, Yumio Fujioka, Shogo Nagamatsu, Kazunori Yokota, Mitsunobu Harima, Shuji Yamashita

Abstract

Objective

Once established, lymphorrhea typically persists and can present as an external lymphatic fistula. Lymphorrhea occurs in limbs with severe lymphedema, as a complication after lymphatic damage, and in obese patients. Some cases are refractory to conservative treatment and require surgical intervention. Reconstruction of a lymphatic drainage route is considered ideal treatment for lymphorrhea. In this study, we reviewed the efficacy of lymphaticovenous anastomoses as a treatment for lymphorrhea of any etiology.

Patients & Methods

The study included 12 patients with lymphorrhea: primary lymphedema (n=3), age-related lymphedema (n=4), lymphorrhea due to lipedema (n=3), or iatrogenic lymphorrhea (n=2). Compression therapy had been performed preoperatively in 10 patients. Compression therapy was difficult to apply in 2 patients. The lymphatic vessels and the veins were anastomosed end-to-end using 12-0 nylon suture under a microscope.

Results

The lymphaticovenous anastomosis was successful in all cases and there were no perioperative complications. The volume of lymphorrhea decreased within 5 days after the surgery in all cases and resolved completely by 2 weeks postoperatively. The compression therapy applied preoperatively was continued postoperatively. There has been no postoperative recurrence of lymphorrhea or cellulitis.