Minimally invasive multiple lymphaticovenular anastomosis at the ankle for the prevention of lower leg lymphedema.
BACKGROUND
The patients with secondary unilateral lower limb lymphedema are likely to experience lymphedema of the contralateral leg in the future. Our policy is to perform preventive lymphaticovenular anastomosis (LVA) of the contralateral limb without symptoms in these patients. In this report, we describe a minimally invasive preventive LVA procedure and present the preliminary results.


METHODS
Ten patients with unilateral lower leg lymphedema underwent multiple LVA procedures through a skin incision over the ankle of the contralateral limb without symptoms. The Campisi clinical stage of these limbs without symptoms was stage 0 in five cases and stage 1A in five cases. The number of anastomoses performed through the incision over the ankle was two LVAs in five cases, three LVAs in four cases, and four LVAs in one case.


RESULTS
All the multiple LVAs were completed without complications. The onset of postoperative cellulitis and edematous aggravation of the limb that received the minimally invasive preventive LVA procedure was not noted in any patient during 6-month follow-up period.


CONCLUSIONS
This minimally invasive preventive LVA procedure might prevent lymphedema and improve the physical appearance of the limb with minimal scarring. Long-term follow-up will be necessary to monitor the future progression of edema in these patients.
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Satoshi
S
Onoda
Takeshi
T
Todokoro
Hisako
H
Hara
Shuchi
S
Azuma
Aya
A
Goto
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000842:Ankle / Q000601:surgery*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D014699:Venules / Q000601:surgery*