Functional lymphaticovenular anastomosis for peripheral lymphedema: incision selection methods with muscle pumping

Abstract

Lymphaticovenular anastomosis (LVA) is a highly effective, minimally invasive surgical treatment for lymphedema. The clinical effect of LVA begins immediately after the creation of the lymph-to-venous pathway. However, the long-term effect of LVA is not always promised when the lymph-to-venous bypass has any potential risk of occlusion, especially when the disorder has reached the late stage. The reasons of postoperative LVA occlusion are considered both a technical matter in performing LVA and a strategic matter in planning LVA. This article focuses on the effective preoperative LVA planning methodology of “functional LVA” for peripheral lymphedema, in which continuous and strong lymph flow at the anastomosis is created by the muscle pumping power of patients’ natural motions at the selected incision point. The current functional LVAs which we have developed are the dynamic LVA method for upper extremity lymphedema and the superior-edge-of-the-knee incision method for lower extremity lymphedema. Because these methods reduce the risk of postoperative LVA occlusion by continuous lymph-to-venous flow at the LVA, functional LVAs keep long-term clinical effect in reduction of lymphedema.

Keywords

Lymphedema / lymphaticovenular anastomosis / supermicrosurgery / functional LVA / dynamic LVA method / superior-edge-of-the-knee incision method / surgery

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