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  • Title: Supermicrosurgical anastomosis of superficial lymphatic vessel to deep lymphatic vessel for a patient with cellulitis-induced chronic localized leg lymphedema.
    Author: Yamamoto T, Koshima I.
    Journal: Microsurgery; 2015 Jan; 35(1):68-71. PubMed ID: 25197031.
    Abstract:
    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.
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