Antegrade and retrograde lymphatico-venous anastomosis for cancer-related lymphedema with lymphatic valve dysfuction and lymphatic varix.
In healthy people, no retrograde lymph flow occurs because of valves in collecting lymph vessels. However, in secondary lymphedema after lymph node dissection, lymph retention and lymphatic hypertension occurs and valvular dysfunction induces retrograde lymph flow. In this case reported, we focused on retrograde lymph flow and performed retrograde lymphatico-venous anastomosis (LVA) simultaneously with antegrade LVA. A 67-year-old Japanese woman had worsening edema in her right thigh and hip area for 3 years. She had previously undergone extended hysterectomy with lymph node dissection for endometrial cancer 8 years before. Indocyanine green test showed antegrade and retrograde lymph flow. Four LVAs were made in the right medial thigh and right lower abdominal area under local anesthesia. Lymphedema showed rapid improvement within 12 months and compression therapy was not required at 24 months after LVA. Retrograde LVA has a possibility of a more efficacy for secondary lymphedema.
Department of Plastic Surgery and Reconstructive Surgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan. mihara@keiseigeka.name
Makoto
M
Mihara
Hisako
H
Hara
Takuya
T
Iida
Takeshi
T
Todokoro
Takumi
T
Yamamoto
Mitsunaga
M
Narushima
Kensuke
K
Tashiro
Noriyuki
N
Murai
Isao
I
Koshima
D000368:Aged; D000714:Anastomosis, Surgical; D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D042601:Lymphatic Vessels / Q000503:physiopathology / Q000601:surgery*; D008209:Lymphedema / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D014680:Veins / Q000601:surgery*