Depatment of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland.
Microsurgery. 2022 Jan;42(1):22-31. doi: 10.1002/micr.30701. Epub 2021 Jan 4.
Superficial lymphovenous anastomosis (LVA) is a widely accepted procedure for treatment of mild-to-moderate lymphedema throughout the body. Anyway, not always are the superficial lymphatic vessels suitable for the anastomosis nor do they provide a sufficient drainage to significantly improve the condition. The continuous progress of supermicrosurgical technique over the last few years and the recent anatomical researches about the deep lymphatic network opened new perspectives for those lymphedema cases refractory to conventional procedures. Resorting to deep lymphatic vessels offer an additional opportunity to further improve the result obtained by means of superficial LVA. The aim of this report is to describe our experience treating lymphedema with superficial and deep lymphatic vessels LVA.
Eight female patients presenting secondary (seven cases) and primary (one case) lymphedema, previously treated by means of multiple superficial LVAs, were considered eligible for deep lymphatics surgery to further improve their results. The affected area was the upper limb in one case and the lower limbs in seven cases. All the patients were evaluated preoperatively and postoperatively resorting to Campisi criteria. Four cases were initially classified as stage III, two stage IV, and two stage II. Five patients received deep LVA in the groin, two patients in the ankle along the posterior tibial artery and one in the wrist along the radial artery.
In all eight patients both subjective and objective improvements of the condition were reported with decrease of swelling and relief from heaviness sensation. The postoperative course was always uneventful and at the 9 months follow up none of the patients presented recurrence of the disease, even with the complete removal of compressive therapy.
Deep lymphatic vessels LVA might represent a valid alternative to the superficial ones to treat lymphedema when previous results are not satisfactory nor when no superficial lymphatic vessels are available for anastomosis.
浅表淋巴管静脉吻合术（LVA）是治疗全身轻中度淋巴水肿的广泛接受的方法。然而，并非所有浅表淋巴管都适合吻合，也并非都能提供足够的引流以显著改善病情。近年来，超显微外科技术的不断进步以及最近对深部淋巴网络的解剖研究，为那些对常规手术治疗反应不佳的淋巴水肿病例开辟了新的前景。利用深部淋巴管为进一步改善通过浅表 LVA 获得的结果提供了额外的机会。本报告旨在描述我们使用浅表和深部淋巴管 LVA 治疗淋巴水肿的经验。
八名女性患者，均患有继发性（七例）和原发性（一例）淋巴水肿，先前已通过多次浅表 LVA 治疗，被认为适合进行深部淋巴管手术以进一步改善其结果。受影响的区域为一例上肢和七例下肢。所有患者均在术前和术后通过 Campisi 标准进行评估。四例最初分类为 III 期，两例为 IV 期，两例为 II 期。五例在腹股沟进行深部 LVA，两例在踝关节沿胫后动脉进行，一例在腕关节沿桡动脉进行。
在所有八例患者中，均报告了病情的主观和客观改善，肿胀减轻，沉重感缓解。术后过程始终平稳，在 9 个月的随访中，没有患者出现疾病复发，即使完全去除了压迫治疗。
当先前的结果不理想或没有浅表淋巴管可供吻合时，深部淋巴管 LVA 可能是治疗淋巴水肿的浅表淋巴管的有效替代方法。
