Summary
Background
Lymphoedema can be treated conservatively or surgically. Early treatment is important,
but the surgical indication and the effect of surgery on pain in lymphoedema-affected
limbs have not been described. The objective of this study was to examine the effect
of low-invasive scarless lymphatic venous anastomosis (LVA) for early or latent lymphoedema.
Methods
LVA was performed in six patients (eight legs) with leg lymphoedema between April
2010 and March 2011. Lymphoedema was stage 0 (defined as subclinical) in three patients
(five legs) and stage 1 in three patients (three legs). Subjective symptoms, circumference
of the affected leg and a lymphoscintigram were evaluated before and 6 months after
surgery. Preoperatively, subcutaneous lymph vessels and veins were identified non-invasively
using ICG lymphoscintigraphy and non-invasive instruments for visualising subcutaneous
vein, AccuVein system, through the skin. These vessels and veins were secured with
vessel loops passed underneath and side-to-side anastomosed under a surgical microscope.
Results
Subjective symptoms improved after surgery in all patients. The leg circumference
improved in stage 1 cases, which all had an increased circumference before surgery.
Lymph retention was observed on preoperative lymphoscintigraphy in all six patients
and was improved after surgery in all cases.
Conclusions
Scarless LVA performed through a small incision improves abnormal lymph circulation
and subjective symptoms in cases of early lymphoedema, in which the limb circumference
has just started to increase, and latent lymphoedema, in which the circumference has
not increased, but abnormal findings on lymphoscintigraphy or subjective symptoms
are present.
Keywords
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Article info
Publication history
Published online: July 23, 2012
Accepted:
May 26,
2012
Received:
December 9,
2011
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
