title: Combined conservative treatment and lymphatic venous anastomosis for severe lower limb lymphedema with recurrent cellulitis.
abstract: BACKGROUND
  Lymphedema may be treated either conservatively or surgically. Although conservative therapy is the first-line treatment, some patients are refractory to it and repeat severe cellulitis. We usually perform lymphaticovenous anastomosis (LVA) for lymphedema patients, and LVA can reduce the frequency of cellulitis.
  
  
  METHODS
  A 67-year-old woman who had undergone a radical hysterectomy, pelvic lymphadenectomy, and postoperative radiotherapy for cervical cancer at the age 50 years. She developed lymphedema in both legs, and high-pressure compression stockings caused lymphorrhea in the groin and thigh, resulting in recurrent episodes of cellulitis. Lymphoscintigraphy revealed dilation of the lymphatic vessels in both legs. Results of an indocyanine green test revealed dermal backflow throughout the lower body. After wearing low-pressure stocking, we performed LVA to reduce cellulitis. After confirming the result of LVA, the patients started wearing high-pressure stocking. The patient underwent a subsequent LVA, 3 months after the first, to further improve edema. The lymphorrhea resolved, and cellulitis did not recur.
  
  
  CONCLUSIONS
  The combination of surgical treatment and conservative treatment is important for severe lymphedema treatment. Although conservative treatment is usually said to be the first-line treatment, LVA can antecede in cases refractory to conservative treatment.
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: Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan; Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Hisako
authors.initials: H
authors.lastname: Hara
authors.affiliation: Department of Nursing, Saiseikai Kawaguchi General Hospital, Saitama, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Tsubaki
authors.affiliation: Department of Nutrition, Saiseikai Kawaguchi General Hospital, Saitama, Japan.
authors.forename: Takiko
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Nutrition, Saiseikai Kawaguchi General Hospital, Saitama, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Yamada
authors.affiliation: Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Kawahara
authors.affiliation: Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Murai
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D002481:Cellulitis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008197:Lymph Node Excision / Q000009:adverse effects*; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008220:Lymphography; D061305:Lymphoscintigraphy; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012008:Recurrence; D012720:Severity of Illness Index; D053828:Stockings, Compression / Q000009:adverse effects; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000628:therapy*