Seki Yukio, Kajikawa Akiyoshi, Yamamoto Takumi, Takeuchi Takayuki, Terashima Takahiro, Kurogi Norimitsu
Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, Kanagawa, Japan; Department of Plastic and Reconstructive Surgery, Shonan Atsugi Hospital, Kanagawa, Japan; and Department of General Surgery, Shonan Atsugi Hospital, Kanagawa, Japan.
Plast Reconstr Surg Glob Open. 2018 Feb 26;6(2):e1679. doi: 10.1097/GOX.0000000000001679. eCollection 2018 Feb.
Surgical treatment of lower extremity lymphedema (LEL) remains challenging. Application of the superior-edge-of-the-knee incision method for lymphaticovenular anastomosis (LVA) is reported to have a strong therapeutic effect in patients with LEL because lymph-to-venous flow at the anastomosis is enhanced by knee joint movement during normal walking. We investigated whether a single LVA created by this method is adequate for early LEL.
The study involved 10 patients with LEL characterized by stage 2 or 3 leg dermal backflow and treated by a single LVA at the thigh via the superior-edge-of-the-knee incision method. The lymphatic vessel and direction of flow were assessed intraoperatively, and reduction in lymphedema volume was assessed postoperatively.
Use of our incision method yielded a single anastomosis in all patients with stage 2 leg dermal backflow and in all patients with stage 3 leg dermal backflow. The lymphatic vessel was 0.65 ± 0.08 mm in diameter (0.65 ± 0.09 and 0.65 ± 0.09 mm, respectively; = 1.000). No venous reflux occurred in any patient. Mean follow-up was 7.70 ± 3.30 months (9.60 ± 3.29 and 5.80 ± 2.17 months, respectively; = 0.068). Mean reduction in the LEL index was 20.160 ± 9.892 (22.651 ± 12.272 and 17.668 ± 7.353, respectively; = 0.462).
A single LVA created by the superior-edge-of-the-knee incision method can be expected to have a strong therapeutic effect in patients with stage 2 or 3 leg dermal backflow.
下肢淋巴水肿（LEL）的手术治疗仍然具有挑战性。据报道，采用膝上缘切口法进行淋巴管静脉吻合术（LVA）对LEL患者具有较强的治疗效果，因为在正常行走过程中，膝关节运动可增强吻合处的淋巴向静脉的流动。我们研究了通过这种方法进行的单次LVA是否足以治疗早期LEL。
本研究纳入了10例LEL患者，其特征为腿部皮肤逆流处于2期或3期，并通过膝上缘切口法在大腿进行单次LVA治疗。术中评估淋巴管及其血流方向，术后评估淋巴水肿体积的减少情况。
采用我们的切口方法，所有腿部皮肤逆流2期患者和所有腿部皮肤逆流3期患者均实现了单次吻合。淋巴管直径为0.65±0.08mm（分别为0.65±0.09mm和0.65±0.09mm；P = 1.000）。所有患者均未发生静脉反流。平均随访时间为7.70±3.30个月（分别为9.60±3.29个月和5.80±2.17个月；P = 0.068）。LEL指数的平均降低值为20.160±9.892（分别为22.651±12.272和17.668±7.353；P = 0.462）。
对于腿部皮肤逆流处于2期或3期的患者，采用膝上缘切口法进行单次LVA有望产生较强的治疗效果。
