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The effect of lymphatico‐venous anastomosis for an intractable ulcer at the lower leg in a marked obese patient
Author(s) -
Mihara Makoto,
Hara Hisako,
Todokoro Takeshi,
Seki Yukio,
Iida Takuya,
Koshima Isao,
Murai Noriyuki
Publication year - 2014
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.22141
Subject(s) - medicine , lymphedema , surgery , anastomosis , microsurgery , cancer , breast cancer
Secondary lymphedema occurs after trauma, cancer surgery, or obesity, and wounds in lymphedema can easily become intractable. We report positive results using lymphatico‐venous anastomosis (LVA) to treat a post‐traumatic lymph fistula and an intractable ulcer in a severely obese patient. A 41‐year‐old male (BMI 51.8), one year prior, had a traffic injury, and had an 18‐cm contusion in his right leg. Six months later, lymph leakage in a 14 cm × 8 cm region and a 5 cm × 3 cm skin ulcer occurred in the center of the wound. We made a diagnosis of lymphedema resulting from obesity, accompanied with lymphorrhea and intractable ulcer. He was unable to reach his legs owing to obesity, making complex physical therapy impossible. We performed LVA under local anesthesia. The lymphorrhea healed 2 weeks after the operation and had not recurred 3 months after the operation. The leg lymphedema improved after the surgery without the compression therapy. In cases of intractable ulcers, suspected of being caused by lymphostasis, treatments indicated for lymphedema, for example LVA, may possibly allow satisfactory wound healing. © 2013 Wiley Periodicals, Inc. Microsurgery 34:64–67, 2014.