Changing the Paradigm: Lymphovenous Anastomosis in Advanced Stage Lower Extremity Lymphedema
- Abstract
- Background: Traditionally, lymphovenous anastomosis is not routinely performed in patients with advanced stage lymphedema because of difficulty with identifying functioning lymphatics. This study pniscins the use of duplex ultrasound and magnetic resonance lymphangiography to identify functional lymphatics and reports the clinical outcome of lymphovenous anastomosis in advanced stage lower extremity lymphedema patients.
Methods: This was a retrospective study of 42 patients (50 lower limbs) with advanced lymphedema (late stage 2 or 3) that underwent functional lymphovenous anastomoses. Functional lymphatic vessels were identified preoperatively using magnetic resonance lymphangiography and duplex ultrasound.
Results: An average of 4.64 lymphovenous anastomoses were performed per limb using the lymphatics located in the deep fat underneath the superficial fascia. The average diameter of lymphatic vessels was 0.61 mm (range, 0.35 to 1 mm). The average limb volume was reduced 14.0 percent post-operatively, followed by 15.2 percent after 3 months, and 15.5 percent after 6 months and 1 year (p < 0.001). For patients with unilateral lymphedema, 32.4 percent had less than 10 percent volume excess compared to the contralateral side post, operatively, whereas 20.5 percent had more than 20 percent volume excess. The incidence of cellulitis decreased from 0.84 per year to 0.07 per year after surgery (p< 0.001).
Conclusion: This study shows that functioning lymphatic vessels can be identified preoperatively using ultrasound and magnetic resonance lymphangiography; thus, lymphovenous anastomoses can effectively reduce the volume of the limb and improve subjective symptoms in patients with advanced stage lymphedema of the lower extremity.
- Author(s)
- 박창식; 서현석; 오태민; 전재용; 조민정; 차한규; 홍준표
- Issued Date
- 2021
- Type
- Article
- Keyword
- breast cancer; indocyanine green; lymphangiography; lymphedema; observer
- DOI
- 10.1097/PRS.0000000000007507
- URI
- https://oak.ulsan.ac.kr/handle/2021.oak/7542
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2448412335&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Changing%20the%20Paradigm:%20Lymphovenous%20Anastomosis%20in%20Advanced%20Stage%20Lower%20Extremity%20Lymphedema&offset=0&pcAvailability=true
- Publisher
- PLASTIC AND RECONSTRUCTIVE SURGERY
- Location
- 미국
- Language
- 영어
- ISSN
- 0032-1052
- Citation Volume
- 147
- Citation Number
- 1
- Citation Start Page
- 199
- Citation End Page
- 207
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- Medicine > Medicine
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