title: Ladder-shaped lymphaticovenular anastomosis using multiple side-to-side lymphatic anastomoses for a leg lymphedema patient.
abstract: Lymphatic supermicrosurgery, supermicrosurgical lymphaticovenular anastomosis (LVA), is becoming a useful option for the treatment of compression-refractory lymphedema. One of the most important points in LVA is to make as many bypasses as possible for better treatment results. We report a progressive lower extremity lymphedema (LEL) case successfully treated with a ladder-shaped LVA. A 67-year-old female with secondary LEL refractory to conservative treatments underwent LVA. A ladder-shaped LVA was performed at the left ankle. In the ladder-shaped LVA, 3 lymphatic vessels and 1 vein were anastomosed in a side-to-side fashion; 2 lymphatic vessels next to the vein were anastomosed to the vein, and the other lymphatic vessel was anastomosed to the nearby lymphatic vessel. Using ladder-shaped LVA, 6 lymph flows of 3 lymphatic vessels could be bypassed into a vein. Six months after the LVA operation, her left LEL index decreased from 212 to 195, indicating edematous volume reduction. Ladder-shaped LVA may be a useful option when there are 3 lymphatic vessels and 1 vein in a surgical field.
authors.affiliation: Department of Plastic and Reconstructive Surgery, the University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Kazuki
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007866:Leg; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema; D011183:Postoperative Complications / Q000601:surgery; D014594:Uterine Neoplasms / Q000601:surgery; D014654:Vascular Patency; D014699:Venules / Q000601:surgery*