title: Multisite Lymphaticovenular Bypass Using Supermicrosurgery Technique for Lymphedema Management in Lower Lymphedema Cases.
abstract: BACKGROUND
  The impact of lymphaticovenous anastomosis on lymphedema has yet to be defined. The authors investigated the clinical evidence regarding the effectiveness of lymphaticovenous anastomosis in lower limb lymphedema.
  
  
  METHODS
  Eighty-four patients (162 limbs; 73 female and 11 male patients) with lower limb lymphedema who underwent multisite lymphaticovenous anastomosis in the authors' clinic between August of 2010 and May of 2014 were included in this retrospective study. Lymphedema was diagnosed using lymphoscintigraphy and indocyanine green lymphography. All lymphaticovenous anastomoses were performed under local anesthesia. The lymphatic vessels that were identified were classified using the normal, ectasis, contraction, and sclerosis type (NECST) classification. Limb circumference, subjective symptoms, and frequency of cellulitis were evaluated.
  
  
  RESULTS
  The average patient age was 60 years (range, 24 to 94 years); mean postoperative follow-up period was 18.3 months (range, 6 to 51 months). The postoperative change rate in limb circumference indicated that 67 limbs (47.7 percent) were classified as improved, 35 (27.3 percent) were classified as stable, and 32 (25 percent) were classified as worse. Postoperative interview revealed improvement in subjective symptoms in 67 limbs (61.5 percent), no change in 38 (34.9 percent), and exacerbation in four (3.7 percent). The postoperative mean occurrence of cellulitis was decreased to 0.13 times per year compared with 0.89 preoperatively, which was statistically significant (p = 0.00084). Multiple regression analysis using the postanastomosis limb circumference and NECST classification confirmed the following results: change rate (percent) = -0.40 + (0.30 × N) + (-0.84 × E) + (0.22 × C) + (-0.61 × S).
  
  
  CONCLUSIONS
  Lymphaticovenous anastomosis is effective for lower limb lymphedema, in point of limb circumference, subjective symptoms, and the frequency of cellulitis.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Saitama, Tokyo, and Chiba, Japan.|From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic and Reconstructive Surgery and the Graduate School of Medicine, University of Tokyo.
authors.forename: Makoto
authors.initials: M
authors.lastname: Mihara
authors.affiliation: Saitama, Tokyo, and Chiba, Japan.|From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic and Reconstructive Surgery and the Graduate School of Medicine, University of Tokyo.
authors.forename: Hisako
authors.initials: H
authors.lastname: Hara
authors.affiliation: Saitama, Tokyo, and Chiba, Japan.|From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic and Reconstructive Surgery and the Graduate School of Medicine, University of Tokyo.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Tange
authors.affiliation: Saitama, Tokyo, and Chiba, Japan.|From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic and Reconstructive Surgery and the Graduate School of Medicine, University of Tokyo.
authors.forename: Han Peng
authors.initials: HP
authors.lastname: Zhou
authors.affiliation: Saitama, Tokyo, and Chiba, Japan.|From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic and Reconstructive Surgery and the Graduate School of Medicine, University of Tokyo.
authors.forename: Mari
authors.initials: M
authors.lastname: Kawahara
authors.affiliation: Saitama, Tokyo, and Chiba, Japan.|From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic and Reconstructive Surgery and the Graduate School of Medicine, University of Tokyo.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: Saitama, Tokyo, and Chiba, Japan.|From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic and Reconstructive Surgery and the Graduate School of Medicine, University of Tokyo.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Murai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D004396:Coloring Agents / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green / Q000494:pharmacology; D035002:Lower Extremity / Q000601:surgery*; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D008209:Lymphedema / Q000175:diagnosis / Q000601:surgery*; D008220:Lymphography / Q000379:methods; D061305:Lymphoscintigraphy; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green