title: Case report: a new hybrid surgical approach for treating mosaic pattern secondary lymphedema in the lower extremities.
abstract: Two of the most common surgical lymph reconstructive interventions for the treatment of secondary lymphedema today are lymphaticovenous anastomosis (LVA) and lymph node transplant. However, neither of these approaches has proven enough evidence to be considered as an effective treatment measure. In this case report, we will introduce a "hybrid method" where combinations of these two conventional methods are used in treating a 52-year-old female patient who displays a mosaic pattern of aggravating secondary lymphedema. Preoperative indocyanine green lymphography assessment was used to identify the different stages of lymphedema within the symptomatic limbs. The application of the hybrid method has resulted in a faster improvement in limb circumference and tissue tenderness compared with when only LVA is performed and has resulted in successful recovery from lymphedema in our case. The hybrid method allows surgeons to select the most appropriate surgical approach for each region displaying a different severity staging of lymphedema, establishing a new order-made remedy for chronic secondary lymphedema patients.
authors.affiliation: Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan. Electronic address: mihara.plasticsurgery@gmail.com.
authors.forename: Makoto
authors.initials: M
authors.lastname: Mihara
authors.affiliation: Undergraduate of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Han Peng
authors.initials: HP
authors.lastname: Zhou
authors.affiliation: Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan; Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Hara
authors.affiliation: Undergraduate of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Tange
authors.affiliation: Department of Health Communication, The University of Tokyo, Tokyo, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Haragi
mesh_terms: D000714:Anastomosis, Surgical; D001458:Bandages; D005260:Female; D006801:Humans; D007044:Hysterectomy; D035002:Lower Extremity / Q000601:surgery*; D008197:Lymph Node Excision; D008209:Lymphedema / Q000209:etiology / Q000601:surgery*; D008220:Lymphography; D008875:Middle Aged; D013524:Surgical Flaps; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery