MicrosurgeryMechanical Dilation Using Nylon Monofilament Aids Multisite Lymphaticovenous Anastomosis Through Improving the Quality of AnastomosisYoshida, Shuhei MD*; Koshima, Isao MD*; Sasaki, Ayano MD†; Fujioka, Yumio MD†; Nagamatsu, Shogo MD†; Yokota, Kazunori MD†; Yamashita, Shuji MD‡; Harima, Mitsunobu MD‡Author Information From the *International Center for Lymphedema and †Plastic and Reconstructive Surgery, Hiroshima University Hospital, Hiroshima; and ‡Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. Received July 25, 2018, and accepted for publication, after revision September 7, 2018. Conflicts of interest and sources of funding: none declared. Reprints: Shuhei Yoshida, MD, International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima City, 734-8551 Japan. E-mail: firstname.lastname@example.org. Annals of Plastic Surgery: February 2019 - Volume 82 - Issue 2 - p 201-206 doi: 10.1097/SAP.0000000000001681 Buy Metrics Abstract Lymphaticovenous anastomosis (LVA) is now a common treatment for lymphedema. It is important to create as many bypasses as possible to maximize the efficacy of LVA. We have developed a method whereby nylon monofilaments are placed inside the vessel lumen to act as dilators. We refer to this technique as mechanical dilation (MD) to distinguish it from intravascular stenting. In this study, we investigated the efficacy of the conventional supermicrosurgery technique performed with and without MD as a treatment for lower limb lymphedema. The LVA was performed using conventional supermicrosurgery alone in 10 patients (group without MD) and in combination with MD in another 10 patients (group with MD). The mean number of successful LVAs performed per hour was significantly higher in the group with MD than in the group without MD (1.42 ± 0.16 vs 1.14 ± 0.15; P < 0.05). The mean amount of improvement in the lower extremity lymphedema index was significantly greater in the group with MD than in the group without MD (7.34 ± 1.57 vs 4.41 ± 1.53; P = 0.003 < 0.05). A statistically significant correlation was found between the number of successful LVAs and amount of improvement in lymphedema (r = 0.449, P = 0.047 < 0.05). Our findings suggest that use of MD does not shorten the operating time or increase the number of LVAs that can be performed but may make it possible to increase the number of successful LVAs that can be performed between vessels with a diameter of less than 0.3 mm. Use of MD could increase the improvement rate of lymphedema to a greater extent than that achieved by conventional microsurgery alone. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.