title: Modified lambda-shaped lymphaticovenular anastomosis with supermicrosurgical lymphoplasty technique for a cancer-related lymphedema patient.
abstract: Supermicrosurgical lymphaticovenular anastomosis (LVA) has become a useful option for the treatment of compression-refractory lymphedema with its effectiveness and less invasiveness. It is important to make as many bypasses as possible for better treatment results of LVA operation. We report a secondary lymphedema case successfully treated using a modified lambda-shaped LVA. A 62-year-old female with secondary lower extremity lymphedema (LEL) refractory to conservative treatments underwent LVA operation. A modified lambda-shaped LVA was performed at the left groin. In modified lambda-shaped LVA, two lymphatic vessels were transected, and both ends of the proximal and distal sides were converged respectively for an end-to-side and end-to-end anastomoses to one vein. Using modified lambda-shaped LVA, four lymph flows of two lymphatic vessels could be bypassed into a vein. Six months after the LVA surgery, her left LEL index decreased from 261 to 247, indicating edematous volume reduction. Modified lambda-shaped LVA effectively bypasses all lymph flows from two lymphatic vessels, when only one large vein can be found in the surgical field.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.forename: Nana
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Ai
authors.initials: A
authors.lastname: Yokoyama
authors.forename: Kensuke
authors.initials: K
authors.lastname: Tashiro
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000209:etiology / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D014594:Uterine Neoplasms / Q000150:complications; D014699:Venules / Q000601:surgery*