title: Supermicrosurgical anastomosis of superficial lymphatic vessel to deep lymphatic vessel for a patient with cellulitis-induced chronic localized leg lymphedema.
abstract: Supermicrosurgical lymphaticovenular anastomosis (LVA) has been reported to be useful for the treatment of obstructive lymphedema. However, LVA has a potential risk of anastomosis site thrombosis. It is more physiological to use a lymphatic vessel as a recipient vessel of lymphatic bypass surgery, because there is no chance for blood to contact the anastomosis site. We report a chronic localized lower leg lymphedema case treated with supermicrosurgical superficial-to-deep lymphaticolymphatic anastomosis (LLA). A 66-year-old male with a 60-year history of cellulitis-induced left lower leg lymphedema suffered from very frequent episodes of cellulitis and underwent LLA under local infiltration anesthesia. LLA was performed at the dorsum of the left foot. A dilated superficial lymphatic vessel was found in the fat layer, and a nondilated intact deep lymphatic vessel was found along the dorsalis pedis artery below the deep fascia. The superficial lymphatic vessel was supermicrosurgically anastomosed to the deep lymphatic vessel in a side-to-end fashion. After the surgery, the patient had no episodes of cellulitis, and the left lower leg lymphedematous volume decreased. Superficial-to-deep LLA may be a useful option for the treatment of secondary lymphedema due to obstruction of only the superficial lymphatic system.
authors.affiliation: Department of Plastic and Reconstructive Surgery, the University of Tokyo, Tokyo, Japan; Department of Plastic Surgery, Noda Hospital, Chiba, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D002481:Cellulitis / Q000150:complications* / Q000601:surgery*; D002908:Chronic Disease; D006801:Humans; D007866:Leg / Q000601:surgery; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*