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Minimal Invasive Lymphaticovenular Anastomosis Under Local Anesthesia for Leg Lymphedema: Is It Effective for Stage III and IV?

Koshima, Isao MD; Nanba, Yuzaburo MD; Tsutsui, Tetsuya MD; Takahashi, Yoshio MD; Itoh, Seiko MD; Fujitsu, Misako MD

doi: 10.1097/01.sap.0000120319.89926.07
Original Article
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This is the first report on the effectiveness of minimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema. Fifty-two patients (age: 15 to 78 years old; 8 males, 44 females) were treated with lymphaticovenular anastomoses under local anesthesia and by postoperative compression using elastic stockings. The average duration of edema of these patients before treatment was 5.3 ± 5.0 years. The average number of anastomosis in each patient was 2.1 ± 1.2 (1–5). The patients were followed for an average of 14.5 ± 10.2 months, and the result were considered effective (82.5%) even for the patients with stage III (progressive edema with acute lymphangitis) and IV (fibrolymphedema), but others showed no improvement. Among these cases, 17 patients showed reduction of over 4 cm in the circumference of the lower leg. The average decrease in the circumference excluding edema in bilateral legs was 41.8 ± 31.2% of the preoperative excess length. These results indicate that minimal invasive lymphaticovenular anastomosis under a local anesthesia is valuable instead of general anesthesia.

Fifty-two patients with leg lymphedema were treated with lymphaticovenular anastomoses under local anesthesia with postoperative compression. The procedure was effective in 82.5%, with 17 patients demonstrating reduction of >4 cm in lower leg circumference.

From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Dentistry, Okayama University, Okayama, Japan.

Received February 22, 2003 and accepted for publication, after revision, January 12, 2004.

A part of this work was presented at the 44th Annual Meeting of the Japanese Society of Plastic and Reconstructive Surgery in Osaka, on April 12, 2001; the 5th International Course on Perforator Flaps in Gent, Belgium, on September 28, 2001; and the 2nd World Society for Reconstructive Microsurgery in Heidelberg, Germany, on June 11, 2003.

Reprints: Isao Koshima, MD, Plastic and Reconstructive Surgery, Graduate School of Medicine and Dentistry, Okayama University, 2-5-1, Shikata, Okayama City, 700–8558, Japan. E-mail: plakoshi@cc.okayama-u.ac.jp

© 2004 Lippincott Williams & Wilkins, Inc.