Microsurgery: PDF OnlyMicroscope-Induced Thermal Burns During Lymphaticovenular AnastomosisYoshida, Shuhei MD, PhD*; Koshima, Isao MD, PhD*; Imai, Hirofumi MD*; Eldahshoury, Tarek Elsayed Mohamed MRCS, MS*; Sasaki, Ayano MD†; Fujioka, Yumio MD†; Nagamatsu, Shogo MD, PhD†; Yokota, Kazunori MD, PhD†; Harima, Mitsunobu MD‡; Yamashita, Shuji MD, PhD‡Author Information From the *International Center for Lymphedema, Hiroshima University Hospital †Plastic and Reconstructive Surgery, Hiroshima University, Hiroshima ‡Plastic and Reconstructive Surgery, Tokyo University, Tokyo, Japan. Received April 23, 2019, and accepted for publication, after revision August 2, 2019. Conflicts of interest and sources of funding: none declared. Reprints: Shuhei Yoshida, MD, PhD, The International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. E-mail: firstname.lastname@example.org. Annals of Plastic Surgery: December 16, 2019 - Volume Publish Ahead of Print - Issue - doi: 10.1097/SAP.0000000000002116 Buy PAP Metrics Abstract Bright illumination sources using xenon lamps have improved microsurgical visualization under an operating microscope; however, surgeons must recognize the potential for accidental thermal damage to soft tissues. In this article, we present 2 reports of microscopic thermal burn in lymphaticovenular anastomosis (LVA). A 23-year-old woman and a 57-year-old woman with bilateral lymphedema of the legs had LVAs on both legs under local anesthesia. The burn wound in a 23-year-old woman was full thickness, and the one in a 57-year-old woman was deep dermal burn. Both of them healed without skin grafting. Working distance and high illumination intensity are important risk factor. The use of epinephrine as part the local anesthetic mixture that decreases blood flow is also a major risk factor for thermal burns. Lymphaticovenular anastomosis particularly requires high magnification, which leads to increasing the intensity and decreasing the working distance. The surgical conditions around LVA are inherently prone to microscope-induced thermal burns. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.