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Supermicrosurgical Lymphaticovenular Anastomosis (LVA) for Early-Stage (Stage 1–2) Extremity Lymphedema

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Clinical Scenarios in Reconstructive Microsurgery

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Abstract

Lymphedema is a progressive edematous disease due to abnormal lymph circulation. Most lymphedema cases are secondary to lymph flow obstruction. Obstruction of lymph flow causes hypertension and dilatation of distal lymph vessels, resulting in lymphatic valvular insufficiency and further retrograde lymph flows. Since irreversible changes occur in the lymph vessels (lymphosclerosis) and soft tissue (fat deposition and fibrosis) with progression of lymphedema, lymph circulation should be improved at an early stage. Although a mainstay of treatment, compression therapy is merely an anti-symptomatic one and cannot stop progression of lymphedema. Lymph reconstructive surgery is required to improve lymph circulation.

Among various surgeries, supermicrosurgical lymphaticovenular anastomosis (LVA) is a least invasive surgery effective for progressive lymphedema. LVA can be done under local infiltration anesthesia via a 2-cm skin incision without hospitalization. However, LVA is hardly effective for progressed lymphedema complicated with severe lymphosclerosis. Early diagnosis is the most important to maximize the efficacy of the minimally invasive surgery. Indocyanine green (ICG) lymphography is recommended for early diagnosis, since it has the highest sensitivity to detect abnormal circulation. ICG lymphography and LVA are key to successful management of lymphedema.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine (NCGM), Tokyo, Japan

    Takumi Yamamoto

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  1. Takumi Yamamoto
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Correspondence to Takumi Yamamoto .

Section Editor information

  1. Department of Plastic Surgery, University Hospital of Brussels (VUB), Brussels, Belgium

    Assaf Zeltzer MD, PhD, FCC(Plast)

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Yamamoto, T. (2020). Supermicrosurgical Lymphaticovenular Anastomosis (LVA) for Early-Stage (Stage 1–2) Extremity Lymphedema. In: Clinical Scenarios in Reconstructive Microsurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-94191-2_110-1

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  • DOI: https://doi.org/10.1007/978-3-319-94191-2_110-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-94191-2

  • Online ISBN: 978-3-319-94191-2

  • eBook Packages: Springer Reference MedicineReference Module Medicine

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