title: Peri-operative care for patients undergoing lymphaticovenular anastomosis: A systematic review.
abstract: BACKGROUND
  Lymphaticovenular anastomosis (LVA) is a supermicrosurgical procedure that involves the anastomosis of a functional lymphatic channel to a venule. Although peri-operative care might be an important contributor to the success of this technique, evidence about optimal peri-operative care seems limited. This review aims to summarize the peri-operative methods used by authors reporting on LVA.
  
  
  METHODS
  A systematic search of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peri-operative care used by authors was summarized and listed in a pre-defined form. Studies were also graded on quality of evidence by the GRADE system and a lymphedema surgery-specific system.
  
  
  RESULTS
  In total, 22 studies were identified describing peri-operative measures. Although most authors were sparse in their description of peri-operative management, most recommended initiation of conventional compression therapy at 1-4 weeks after surgery. Prophylactic antibiotics, elevation of the affected limb, bandaging, low-molecular-weight heparin, prostaglandin E1, and manual pressure therapy were also described. The quality of evidence of the included studies was low on average.
  
  
  CONCLUSIONS
  Although supermicrosurgical LVAs are gaining in popularity, there are no high-quality prospective trials evaluating these new techniques and the description of peri-operative management is scarce. Of the available studies, a peri-operative management consisting of prophylactic antibiotics, elevation of the affected limb during night and hospital stay, and compression therapy 4 weeks post-surgery for 6 months seems to be preferred. Future studies should describe a detailed peri-operative protocol to allow for a better comparison between study results and to determine optimal peri-operative recommendations.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. Electronic address: harm.winters@radboudumc.nl.
authors.forename: Harm
authors.initials: H
authors.lastname: Winters
authors.affiliation: Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Hanneke J P
authors.initials: HJ
authors.lastname: Tielemans
authors.affiliation: Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Philippe N
authors.initials: PN
authors.lastname: Sprangers
authors.affiliation: Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Dietmar J O
authors.initials: DJ
authors.lastname: Ulrich
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D042601:Lymphatic Vessels / Q000601:surgery*; D008209:Lymphedema / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D019990:Perioperative Care / Q000379:methods*; D014699:Venules / Q000601:surgery*
keywords: Lymphaticovenular anastomosis; Lymphedema surgery; Peri-operative care; Systematic review