Multisite Lymphaticovenular Bypass Using Supermicrosurgery Technique for Lymphedema Management in Lower Lymphedema Cases
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. Eighty-four patients (162 limbs; 73 female and 11 male patients) with lower limb lymphe...
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| Veröffentlicht in: | Plastic and reconstructive surgery (1963) 2016-07, Vol.138 (1), p.262-272 |
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| creator | Mihara, Makoto Hara, Hisako Tange, Shuichi Zhou, Han Peng Kawahara, Mari Shimizu, Yohei Murai, Noriyuki |
| description | 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.
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.
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).
Lymphaticovenous anastomosis is effective for lower limb lymphedema, in point of limb circumference, subjective symptoms, and the frequency of cellulitis.
Therapeutic, IV. |
| doi_str_mv | 10.1097/PRS.0000000000002254 |
| format | Article |
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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.
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).
Lymphaticovenous anastomosis is effective for lower limb lymphedema, in point of limb circumference, subjective symptoms, and the frequency of cellulitis.
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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.
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).
Lymphaticovenous anastomosis is effective for lower limb lymphedema, in point of limb circumference, subjective symptoms, and the frequency of cellulitis.
Therapeutic, IV.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anastomosis, Surgical - methods</subject><subject>Coloring Agents - pharmacology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Indocyanine Green - pharmacology</subject><subject>Lower Extremity - surgery</subject><subject>Lymphatic Vessels - diagnostic imaging</subject><subject>Lymphatic Vessels - surgery</subject><subject>Lymphedema - diagnosis</subject><subject>Lymphedema - surgery</subject><subject>Lymphography - methods</subject><subject>Lymphoscintigraphy</subject><subject>Male</subject><subject>Microsurgery - methods</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><subject>Vascular Surgical Procedures - methods</subject><subject>Young Adult</subject><issn>0032-1052</issn><issn>1529-4242</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkNtOGzEQhq2qiISUN6iQL3uzMD7u7iWNSqmUCFTI9crZHSeGPdXeLeTtaxoOLbas8Wjm_8f-CPnM4JRBnp5d_7w5hX8W50p-IFOmeJ5ILvlHMgUQPGGg-IQchXAHwFKh1SGZ8FTITKt8Sh6XYz244Aaki13Tb83gyu43tmNtPP26600IdBVcu6E3Y4--caXvwug36Hf0Fstt636NSG3n93KssDF0aVqzwQbbgbqWLroH_K88NwHDJ3JgTR3w-DnOyOri2-38Mllcff8xP18kpWSZSlSl5Vpqa1WVlUobqWxexg3xbq1hSmmeVSDKdW65XjMpZMW0kKZKM5lzEDPyZe_b-y4-NQxF40KJdW1a7MZQsAxAAmeZiK1y3_r0x-DRFr13jfG7gkHxxLyIzIv3zKPs5HnCuG6wehW9QH7zfejqAX24r8dIpNiiqYftXz-thEw4MA1pzJJ4pBJ_AFBbjgY</recordid><startdate>20160701</startdate><enddate>20160701</enddate><creator>Mihara, Makoto</creator><creator>Hara, Hisako</creator><creator>Tange, Shuichi</creator><creator>Zhou, Han Peng</creator><creator>Kawahara, Mari</creator><creator>Shimizu, Yohei</creator><creator>Murai, Noriyuki</creator><general>by the American Society of Plastic Surgeons</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160701</creationdate><title>Multisite Lymphaticovenular Bypass Using Supermicrosurgery Technique for Lymphedema Management in Lower Lymphedema Cases</title><author>Mihara, Makoto ; Hara, Hisako ; Tange, Shuichi ; Zhou, Han Peng ; Kawahara, Mari ; Shimizu, Yohei ; Murai, Noriyuki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4185-5d64b46ff5d8c56a45f9c9c9056affa155628d03cb9f26b1434d1634ad7849203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anastomosis, Surgical - methods</topic><topic>Coloring Agents - pharmacology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Indocyanine Green - pharmacology</topic><topic>Lower Extremity - surgery</topic><topic>Lymphatic Vessels - diagnostic imaging</topic><topic>Lymphatic Vessels - surgery</topic><topic>Lymphedema - diagnosis</topic><topic>Lymphedema - surgery</topic><topic>Lymphography - methods</topic><topic>Lymphoscintigraphy</topic><topic>Male</topic><topic>Microsurgery - methods</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><topic>Vascular Surgical Procedures - methods</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mihara, Makoto</creatorcontrib><creatorcontrib>Hara, Hisako</creatorcontrib><creatorcontrib>Tange, Shuichi</creatorcontrib><creatorcontrib>Zhou, Han Peng</creatorcontrib><creatorcontrib>Kawahara, Mari</creatorcontrib><creatorcontrib>Shimizu, Yohei</creatorcontrib><creatorcontrib>Murai, Noriyuki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Plastic and reconstructive surgery (1963)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mihara, Makoto</au><au>Hara, Hisako</au><au>Tange, Shuichi</au><au>Zhou, Han Peng</au><au>Kawahara, Mari</au><au>Shimizu, Yohei</au><au>Murai, Noriyuki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multisite Lymphaticovenular Bypass Using Supermicrosurgery Technique for Lymphedema Management in Lower Lymphedema Cases</atitle><jtitle>Plastic and reconstructive surgery (1963)</jtitle><addtitle>Plast Reconstr Surg</addtitle><date>2016-07-01</date><risdate>2016</risdate><volume>138</volume><issue>1</issue><spage>262</spage><epage>272</epage><pages>262-272</pages><issn>0032-1052</issn><eissn>1529-4242</eissn><abstract>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.
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.
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).
Lymphaticovenous anastomosis is effective for lower limb lymphedema, in point of limb circumference, subjective symptoms, and the frequency of cellulitis.
Therapeutic, IV.</abstract><cop>United States</cop><pub>by the American Society of Plastic Surgeons</pub><pmid>27348659</pmid><doi>10.1097/PRS.0000000000002254</doi><tpages>11</tpages></addata></record> |
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| ispartof | Plastic and reconstructive surgery (1963), 2016-07, Vol.138 (1), p.262-272 |
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| source | Journals@Ovid Ovid Autoload; MEDLINE |
| subjects | Adult Aged Aged, 80 and over Anastomosis, Surgical - methods Coloring Agents - pharmacology Female Follow-Up Studies Humans Indocyanine Green - pharmacology Lower Extremity - surgery Lymphatic Vessels - diagnostic imaging Lymphatic Vessels - surgery Lymphedema - diagnosis Lymphedema - surgery Lymphography - methods Lymphoscintigraphy Male Microsurgery - methods Middle Aged Retrospective Studies Treatment Outcome Vascular Surgical Procedures - methods Young Adult |
| title | Multisite Lymphaticovenular Bypass Using Supermicrosurgery Technique for Lymphedema Management in Lower Lymphedema Cases |
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