Mihara Makoto, Tange Shuichi, Hara Hisako, Han Peng Zhou, Haragi Makiko, Muarai Noriyuki
Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan.
School of Medicine, the University of Tokyo, Tokyo, Japan.
Microsurgery. 2016 Nov;36(8):695-699. doi: 10.1002/micr.22402. Epub 2015 Mar 6.
Lymph vessel flap transplantation (LFT), lymphaticovenous anastomosis (LVA), or lymph node flap transfer are sometimes used to treat lymphedema that is resistant to conservative treatment. LFT harvested from the contralateral limb has been reported for the treatment of lymphedema. Here we report the use of modified LFT from the abdominal wall for the treatment of refractory lymphedema. Our patient was a 57-year-old patient with secondary lower limb lymphedema was previously treated with conservative therapy and lymphaticovenous anastomosis. We first examined the lymphatic function of the lower abdominal region in the patient using indocyanine green (ICG) lymphography. After confirming the good lymphatic function in the right abdominal region, we harvested the pedicled abdominal adiposal flap containing multiple abdominal lymph vessels and transferred it to the left groin region. The flap (20 × 10 cm ) was based on the superficial circumflex iliac artery perforator. We anastomosed one lymph vessel in the flap to that in the recipient site. We also performed multiple fibrotripsy using a 3-mm-diameter stainless steel stick inserted into small incisions. The postoperative course was uneventful. The circumference measurement was decreased by 2.2-13.5 cm at 1 year after the operation. The lower abdominal region has many lymph vessel networks and is thought to be a less risky donor site in patients with lymphedema than the lower limbs. Thus, LFT may be an option for the treatment of chronic lymphedema. © 2015 Wiley Periodicals, Inc. Microsurgery 36:695-699, 2016.
淋巴管瓣移植（LFT）、淋巴静脉吻合术（LVA）或淋巴结瓣转移有时用于治疗对保守治疗耐药的淋巴水肿。据报道，取自对侧肢体的LFT可用于治疗淋巴水肿。在此，我们报告使用改良的腹壁LFT治疗难治性淋巴水肿。我们的患者是一名57岁的继发性下肢淋巴水肿患者，此前接受过保守治疗和淋巴静脉吻合术。我们首先使用吲哚菁绿（ICG）淋巴管造影检查了患者下腹部区域的淋巴功能。在确认右腹部区域淋巴功能良好后，我们切取了包含多条腹部淋巴管的带蒂腹部脂肪瓣，并将其转移至左腹股沟区。该皮瓣（20×10 cm）以旋髂浅动脉穿支为蒂。我们将皮瓣中的一条淋巴管与受区的淋巴管进行了吻合。我们还使用一根直径3毫米的不锈钢棒插入小切口进行了多次纤维组织粉碎术。术后过程顺利。术后1年，周长测量减少了2.2 - 13.5厘米。下腹部区域有许多淋巴管网络，对于淋巴水肿患者来说，该区域被认为是比下肢风险更低的供区。因此，LFT可能是治疗慢性淋巴水肿的一种选择。© 2015威利期刊公司。显微外科学36:695 - 699，2016年。
