title: A modified side-to-end lymphaticovenular anastomosis.
abstract: BACKGROUND
  Lymphaticovenular anastomosis (LVA) is a useful treatment for compression-refractory lymphedema with its effectiveness and minimal invasiveness. However, LVA requires supermicrosurgery, where lymphatic vessels with a diameter of 0.5 mm or smaller are anastomosed using 11-0 or 12-0 suture. To make LVA easier and safer, we adopted a modified side-to-end (S-E) anastomosis in LVA surgery.
  
  
  METHODS
  We performed modified S-E LVAs in 14 limbs of female patients with lower extremity lymphedema (LEL). In modified S-E LVA, lateral windows with a length of 1.0 mm or longer were created on a lymphatic vessel and a vein, respectively, and side-to-side (S-S) anastomosis was established with 10-0 continuous suture. After completion of S-S anastomosis, the vein distal to the anastomosis site was ligated to prevent venous backflow and subsequent thrombosis at the anastomosis site. Lymphedematous volume was evaluated preoperatively and at postoperative 6 months using LEL index.
  
  
  RESULTS
  All the 24 modified S-E anastomoses could be completed without difficulty or revision for anastomosis, and showed good patency after completion of anastomosis. Postoperatively, LEL indices significantly decreased compared with preoperative LEL index (255.9 ± 14.1 vs. 274.9 ± 22.2, P < 0.001).
  
  
  CONCLUSIONS
  Modified S-E LVA can efficaciously divert lymph flows into venous circulation without performing supermicrosurgical anastomosis.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. tyamamoto-tky@umin.ac.jp
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.forename: Yukio
authors.initials: Y
authors.lastname: Seki
authors.forename: Nana
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Timothy Weng Hoh
authors.initials: TW
authors.lastname: Shim
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D035002:Lower Extremity; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D016896:Treatment Outcome; D014699:Venules / Q000601:surgery*