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Supermicrosurgical Lymphaticovenous Anastomosis as an Alternative Treatment Option for Patients with Lymphorrhea

Yang, Johnson Chia-Shen M.D.; Yen, Yuan-Hao M.D.; Wu, Shao-Chun M.D.; Lin, Wei-Che M.D.; Chiang, Min-Hsien M.D.; Hsieh, Ching-Hua M.D.

Plastic and Reconstructive Surgery: November 2019 - Volume 144 - Issue 5 - p 1214-1224
doi: 10.1097/PRS.0000000000006169
Reconstructive: Lower Extremity: Original Articles
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Background: Lymphorrhea is probably the most appalling form of lymphedema and is difficult to treat. Intractable lymphorrhea is prone to infection because of skin breakdown. It is believed that supermicrosurgical lymphaticovenous anastomosis is unsuitable for treating such severe disease. Only a few lymphorrhea patients treated with lymphaticovenous anastomosis have been reported. Whether it can be used to treat lymphorrhea has remained inconclusive.

Methods: From September of 2015 to June of 2018, 105 patients underwent supermicrosurgical lymphaticovenous anastomosis (n = 746) in the authors’ hospital. These patients are divided into the nonlymphorrhea group (three male and seven female patients) and the nonlymphedema group (lymphedema patients without lymphorrhea) (11 male and 84 female patients). Retrospective chart review with demographic data and intraoperative findings were recorded and analyzed. Post–lymphaticovenous anastomosis outcomes for lymphorrhea patients were also recorded.

Results: No significant differences were found in patient age, sex, or affected limbs between these two groups. As for intraoperative findings, no differences were found in the percentage of indocyanine green–enhanced lymphatic vessels (52.7 ± 41.1 percent versus 67.3 ± 36.7 percent; p = 0.227) or the pathologic changes of lymphatic vessels based on the normal, ectasis, contraction, and sclerosis type classification (2.2 ± 1.0 versus 2.1 ± 1.0; p = 0.893) between the lymphorrhea and nonlymphorrhea groups, respectively. The average follow-up period was 14.5 months (range, 3 to 31 months). Five lymphorrhea patients (50 percent) showed complete recovery without relapse; significant lymphorrhea reduction was found in three patients (30 percent), and two patients showed minimal improvements (20 percent).

Conclusion: With comparable functional lymphatic vessels identified in lymphorrhea patients, supermicrosurgical lymphaticovenous anastomosis is a viable option for lymphorrhea treatment, with satisfactory results.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Kaohsiung, Taiwan; and Xiamen, Fujian, People’s Republic of China

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and the Departments of Anesthesiology and Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; and the Department of Plastic and Reconstructive Surgery, Xiamen Changgung Hospital.

Received for publication October 10, 2018; accepted March 7, 2019.

The first two authors contributed equally as co–first authors.

Presented at the Second International Course on Supermicrosurgery, in Jinan, People’s Republic of China, October 12 through 14, 2018; and the 2nd Annual Lymphedema Symposium, Merck Research Laboratories, Beth Israel Deaconess Medical Center, in Boston, Massachusetts, November 1 through 2, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

Ching-Hua Hsieh, M.D., Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and, Chang Gung University College of Medicine, 123 Dapi Road, Niaosong District, Kaohsiung City, Taiwan 833, prs581126@gmail.com

Copyright © 2019 by the American Society of Plastic Surgeons