Efferent Lymphatic Vessel Anastomosis: Supermicrosurgical Efferent Lymphatic Vessel-to-Venous Anastomosis for the Prophylactic Treatment of Subclinical Lymphedema.
BACKGROUND
In lower extremity lymphedema secondary to pelvic cancer treatments, lymphedema develops despite that the inguinal lymph nodes (LNs) are preserved. Obstruction of the efferent lymphatic vessels of the inguinal LNs causes lower extremity lymphedema, and it is considered a radical treatment to bypass the efferent lymphatic vessel.


METHODS
Efferent lymphatic vessel anastomosis, supermicrosurgical efferent lymphatic vessel-to-venous anastomosis, was performed on 14 legs with subclinical lymphedema [leg dermal backflow (LDB) stage I]. Efferent lymphatic vessel anastomosis was performed under local anesthesia at the groin region, and an efferent lymphatic vessel of the inguinal LN is anastomosed to a recipient vein. Feasibility and postoperative results were evaluated.


RESULTS
All 14 efferent lymphatic vessel anastomoses were successfully performed without perioperative complication. All legs could be free from lymphedematous symptoms without perioperative compression at postoperative 1 year. Postoperative LDB stage included LDB stage 0 (n = 8) and LDB stage I (n = 6), which was significantly downstaged compared with preoperative LDB stage (P < 0.001).


CONCLUSIONS
Efferent lymphatic vessel anastomosis allowed lymph flow bypass after filtration by the superficial inguinal LN through a skin incision along the inguinal crease, and was effective to prevent development of symptomatic lymphedema in subclinical lymphedema cases.
From the *Department of Plastic and Reconstructive Surgery, University of Tokyo; and †Department of Plastic Surgery, Toranomon Hospital, Tokyo, Japan.
Takumi
T
Yamamoto
Nana
N
Yamamoto
Marie
M
Yamashita
Megumi
M
Furuya
Akitatsu
A
Hayashi
Isao
I
Koshima
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D058070:Asymptomatic Diseases; D005260:Female; D006119:Groin; D006801:Humans; D007866:Leg; D035002:Lower Extremity / Q000601:surgery; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000517:prevention & control*; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery*