Arch Plast Surg.  2019 Jul;46(4):344-349. 10.5999/aps.2018.01382.

Proximal ligation after the side-to-end anastomosis recovery technique for lymphaticovenous anastomosis

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, University of the Ryukyus, Nishihara, Japan. yushisuzuki-kei@umin.ac.jp
  • 2Department of Plastic and Reconstructive Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
  • 3Department of Plastic and Reconstructive Surgery, Sano Kosei General Hospital, Sano, Japan.

Abstract

BACKGROUND
Lymphaticovenous anastomosis is an important surgical treatment for lymphedema, with lymphaticovenous side-to-end anastomosis (LVSEA) and lymphaticovenous end-to-end anastomosis being the most frequently performed procedures. However, LVSEA can cause lymphatic flow obstruction because of regurgitation and tension in the anastomosis. In this study, we introduce a novel and simple procedure to overcome this problem.
METHODS
Thirty-five female patients with lower extremity lymphedema who underwent lymphaticovenous anastomosis at our hospital were included in this study. Eighty-five LVSEA procedures were performed, of which 12 resulted in insufficient venous blood flow. For these 12 anastomoses, the proximal lymphatic vessel underwent clipping after the anastomotic procedure and the venous inflow was monitored. Subsequently, the proximal ligation after side-to-end anastomosis recovery (PLASTER) technique, which involves ligating the proximal side of the lymphatic vessel, was applied. A postoperative evaluation was performed using indocyanine green 6 months after surgery.
RESULTS
Despite the clipping procedure, three of the 12 anastomoses still showed poor venous inflow. Therefore, it was not possible to apply the PLASTER technique in those cases. Among the nine remaining anastomoses in which the PLASTER technique was applied, three (33%) were patent.
CONCLUSIONS
Our findings show that achieving patent anastomosis is challenging when postoperative venous inflow is poor. We achieved good results by performing proximal ligation after LVSEA. Thus, the PLASTER technique is a particularly useful recovery technique when LVSEA does not result in good run-off.

Keyword

Microsurgery; Lymphatic vessels; Edema; Lymphatic diseases

MeSH Terms

Edema
Female
Humans
Indocyanine Green
Ligation*
Lower Extremity
Lymphatic Diseases
Lymphatic Vessels
Lymphedema
Microsurgery
Indocyanine Green
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