Department of Plastic Surgery, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea.
Department of Plastic Surgery, Asan Medical Center University of Ulsan College of Medicine, Seoul, Korea; Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Plast Reconstr Aesthet Surg. 2021 Sep;74(9):2059-2067. doi: 10.1016/j.bjps.2021.01.005. Epub 2021 Jan 30.
The microsurgical options for lower limb lymphedema is a challenge. In search to improve the overall result, we hypothesized it would be beneficial to add the functioning lymph nodes to vein anastomosis (LNVA) in addition to lymphovenous anastomosis (LVA). This is a retrospective study of 160 unilateral stage II & III lower extremity lymphedema comparing the outcome between the LNVA + LVA group and the LVA only group from May 2013 to June 2018. MRI was used to identify the functioning lymph nodes. Patient outcome, including lower extremity circumference, body weight, bio impedance test, and other data were analyzed to evaluate whether lymph nodes to vein anastomosis (LNVA) improved outcome. The LNVA + LVA group showed significantly better results for circumference reduction rate, body weight reduction rate, and extracellular fluid reduction rate of the affected limb as compared to the LVA only group for both stage II and III lymphedema. The MRI imaging revealed that 9 cases had no identifiable lymph nodes of the affected limb and 54 cases with a nonfunctioning lymph node upon exploration despite positive imaging. Correlation showed the lymph node size needed to be at least 8 mm in the MRI to be functional. The LNVA + LVA approach for lymphedema has the benefit of better reduction as compared to LVA alone in the lower limb as well as the suprapubic region. Preoperative MRI will help to identify the functioning lymph node by increasing the overall probability of positive outcome.
下肢淋巴水肿的显微外科治疗是一个挑战。为了提高整体疗效，我们假设在淋巴管静脉吻合术（LVA）的基础上增加功能性淋巴结到静脉吻合术（LNVA）会有益处。这是一项回顾性研究，比较了 2013 年 5 月至 2018 年 6 月期间 160 例单侧 II 期和 III 期下肢淋巴水肿患者中 LNVA+LVA 组和仅 LVA 组的结果。MRI 用于识别功能性淋巴结。通过分析下肢周径、体重、生物阻抗测试和其他数据来评估淋巴结到静脉吻合术（LNVA）是否改善了结果。与仅行 LVA 的患者相比，LNVA+LVA 组的周径缩小率、体重减轻率和受累肢体细胞外液减少率均显著改善，无论是 II 期还是 III 期淋巴水肿患者。MRI 成像显示，在探查时，9 例患者的受累肢体没有可识别的淋巴结，54 例患者的淋巴结功能异常。相关性分析表明，MRI 中淋巴结的大小至少需要 8mm 才能具有功能。与单独行 LVA 相比，LNVA+LVA 治疗下肢和耻骨上区域的淋巴水肿具有更好的疗效。术前 MRI 将通过提高整体阳性结果的概率，有助于识别功能性淋巴结。
