title: π-shaped lymphaticovenular anastomosis for head and neck lymphoedema: a preliminary study.
abstract: BACKGROUND
  Head and neck lymphoedema secondary to jugular lymphadenectomy is a severe issue, without efficient solution. Successful treatment of lymphoedema of the upper and lower limbs has become possible with supermicrosurgical lymphaticovenular anastomosis. The technique based on two end-to-side anastomosis is named π-shaped lymphaticovenular anastomosis. We have evaluated this method for chronic head and neck lymphoedema.
  
  
  METHODS
  From November 2010 to April 2011, four patients with a chronic head and neck lymphoedema were treated by π-shaped lymphaticovenular anastomosis. Three patients had a unilateral lymphoedema, and one patient had a bilateral lymphoedema. The mean age of the patients was 63.2 years (range, 46-77 years). The mean duration of the lymphoedema was 2.6 years (range, 1-5). Every patient was operated under local anaesthesia through a face-lift skin incision. One π-shaped lymphaticovenular anastomosis was performed at each operative site.
  
  
  RESULTS
  The average operative time to perform one π-shaped lymphaticovenular anastomosis was 1.9 h (range, 1.8-2.5). The calibre of lymphatic vessels used for lymphaticovenular anastomosis ranged from 0.3 to 0.7 mm (average, 0.5). A venous back-flow was found in seven lymphaticovenular anastomosis (70%). Three patients (75%) had a qualitative improvement of skin tissue and a significant circumferential reduction after surgery. The average circumferential differential reduction rate was 3.7% (range, 0.6-7.8) (p=0.006). The average cross-sectional area differential reduction rate was 7.2% (range, 1.2-15.1) (p=0.007). The average volume differential reduction rate was 6.9% (range, 2-14.8) (p=0.05).
  
  
  CONCLUSIONS
  The authors present a new option to treat head and neck lymphoedema. π-Shaped lymphaticovenular anastomosis is an effective method to reduce the severity of skin tissue fibrosis and lymphoedema volume. Further studies with larger groups of patients are required to confirm the outcome of this preliminary study. EBM Level=level 4.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Nimes University Hospital, pl Pr Robert Debré, 30000 Nimes, France. bayestaray@yahoo.fr
authors.forename: Benoit
authors.initials: B
authors.lastname: Ayestaray
authors.forename: Farid
authors.initials: F
authors.lastname: Bekara
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Andreoletti
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome