Methods: Thirty patients with breast cancer treatment-related lymphedema treated by 3 incisions at the forearm for creating lymphaticovenular anastomoses were assessed 5: 15 in whom the dynamic-LVA method were used and 15 in whom the conventional method was used. Intraoperative status of lymphatic vessels and postoperative lymphedematous volume reduction were compared.
Results: Placement of incisions at a total of 90 forearm sites (3 per patient) yielded creation of 90 LVAs (32 in “linear ICG lymphography pattern incisions” and 58 in “stardust pattern incisions.” Sclerotic lymphatic vessels were encountered at greater frequency in "linear pattern incisions” in the dynamic-LVA group than in the conventional LVA group (7.1% vs. 38.9%, P = 0.030). Diameters of the lymphatic vessels did not differ significantly between the conventional LVA group and dynamic LVA group (0.43 ± 0.25 mm vs. 0.47 ± 0.14 mm, respectively; P = 0.332) or in the prevalence of dynamic flow of lymph to veins without venous reflux (64.4% vs. 73.3%, respectively; P = 0.362). Postoperative volume reduction was significantly greater in the dynamic-LVA group than in the conventional LVA group; the UEL index at 1 month was 8.12 ± 3.06 vs. 3.74 ± 5.82, respectively (P = 0.018) and at 6 months was 8.74 ± 3.58 vs. 2.62 ± 10.39, respectively (P = 0.046).
Conclusions: Dynamic-LVA is clinically beneficial because the imaging guides decisions over where the incisions should be placed so that a patient’s natural hand motions can be utilized to propel lymph into the anastomosis despite the presence of sclerotic lymphatic vessels. It is also beneficial because even early improvements are obtained.
- Chang DW, Masia J, Garza R 3rd, Skoracki R, Neligan PC. Lymphedema: surgical and medical therapy. Plast Reconstr Surg. 2016;138:209S–218S.
- Koshima I, Kawada S, Moriguchi T, Kajiwara Y. Ultrastructural observations of lymphatic vessels in lymphedema in human extremities. Plast Reconstr Surg. 1996;97:397–405; discussion 406–407.
- Mihara M, Hara H, Hayashi Y, et al. Pathological steps of cancer-related lymphedema: histological changes in the collecting lymphatic vessels after lymphadenectomy. PLoS One. 2012;7:e41126.
- Yamamoto T, Yamamoto N, Yoshimatsu H, Narushima M, Koshima I. Factors associated with lymphosclerosis: an analysis on 962 lymphatic vessels. Plast Reconstr Surg. 2017;140:734–741.
- Seki Y, Yamamoto T, Kajikawa A. Lymphaticovenular anastomosis for breast cancer treatment-related lymphedema: Three-line strategy for an optimal outcome. J Plast Reconstr Aesthet Surg. 2018 Jun;71(6):e13-e14.