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Supermicrosurgical anastomosis of superficial lymphatic vessel to deep lymphatic vessel for a patient with cellulitis‐induced chronic localized leg lymphedema
Author(s) -
Yamamoto Takumi,
Koshima Isao
Publication year - 2015
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.22327
Subject(s) - medicine , lymphedema , lymphatic system , cellulitis , anastomosis , microsurgery , lymphatic vessel , surgery , secondary lymphedema , deep fascia , anatomy , pathology , cancer , breast cancer , metastasis
Supermicrosurgical lymphaticovenular anastomosis (LVA) has been reported to be useful for the treatment of obstructive lymphedema. However, LVA has a potential risk of anastomosis site thrombosis. It is more physiological to use a lymphatic vessel as a recipient vessel of lymphatic bypass surgery, because there is no chance for blood to contact the anastomosis site. We report a chronic localized lower leg lymphedema case treated with supermicrosurgical superficial‐to‐deep lymphaticolymphatic anastomosis (LLA). A 66‐year‐old male with a 60‐year history of cellulitis‐induced left lower leg lymphedema suffered from very frequent episodes of cellulitis and underwent LLA under local infiltration anesthesia. LLA was performed at the dorsum of the left foot. A dilated superficial lymphatic vessel was found in the fat layer, and a nondilated intact deep lymphatic vessel was found along the dorsalis pedis artery below the deep fascia. The superficial lymphatic vessel was supermicrosurgically anastomosed to the deep lymphatic vessel in a side‐to‐end fashion. After the surgery, the patient had no episodes of cellulitis, and the left lower leg lymphedematous volume decreased. Superficial‐to‐deep LLA may be a useful option for the treatment of secondary lymphedema due to obstruction of only the superficial lymphatic system. © 2014 Wiley Periodicals, Inc. Microsurgery 35:68–71, 2015.