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Changing the Paradigm: Lymphovenous Anastomosis in Advanced Stage Lower Extremity Lymphedema

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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)
박창식서현석오태민전재용조민정차한규홍준표
Issued Date
2021
Type
Article
Keyword
breast cancerindocyanine greenlymphangiographylymphedemaobserver
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&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Changing%20the%20Paradigm:%20Lymphovenous%20Anastomosis%20in%20Advanced%20Stage%20Lower%20Extremity%20Lymphedema&amp;offset=0&amp;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
Appears in Collections:
Medicine > Medicine
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