Gabriele Guido, Benedetti Simone, Cascino Flavia, Ungaro Antonino, Gennaro Paolo
Department of Maxillo-Facial Surgery, S. Maria alle Scotte University Hospital of Siena, Siena, Italy.
J Plast Reconstr Surg. 2023 Oct 12;3(2):43-52. doi: 10.53045/jprs.2023-0017. eCollection 2024 Apr 27.
Supermicrosurgical lymphaticovenular anastomosis represents an established procedure for lymphedema treatment, the effectiveness of which has been well documented in international literature. Nevertheless, currently, no standards for supermicrosurgical lymphaticovenular anastomosis have been established regarding the type, location, and number of anastomoses so that the approach to surgical scenarios still depends on the surgeons' preference and ability. A comprehensive literature search for articles involving supermicrosurgical lymphaticovenular anastomosis techniques was performed on the PubMed/Medline/SCOPUS databases. Results, including the names of the technique and their characteristics, such as indications, surgical time, and configuration of the vessels, are reported. Each technique included was then performed five times, and for each of them, patency was tested intraoperatively and 30 days after surgery. Moreover, an efficacy score was assigned, taking into consideration the number of lymphatic vessels anastomosed, the average time for anastomosis, and the difficulty of each technique. A total of 148 articles resulted from the literature search. In total, 16 papers met the criteria for inclusion as defined in the methods and were included in the review as a "supermicrosurgical lymphaticovenular anastomosis technique." Efficacy scores ranged from 0.21 to 1, intraoperative patency ranged from 80% to 100%, and the 30-days patency test ranged from 60% to 100%. To perform effective anastomoses and aim to maximize the results of supermicrosurgical lymphaticovenular anastomosis, a modern microsurgeon should be trained to recognize and manage the most common vessel configurations, performing the most adequate one of the several techniques described. Further studies are required to validate and compare the use of the supermicrosurgical lymphaticovenular anastomosis techniques reviewed.
超显微外科淋巴管静脉吻合术是一种已确立的治疗淋巴水肿的手术方法，其有效性在国际文献中已有充分记载。然而，目前在吻合的类型、位置和数量方面，尚未建立超显微外科淋巴管静脉吻合术的标准，因此手术方案的选择仍取决于外科医生的偏好和能力。我们在PubMed/Medline/SCOPUS数据库中对涉及超显微外科淋巴管静脉吻合术技术的文章进行了全面的文献检索。报告了检索结果，包括技术名称及其特征，如适应证、手术时间和血管构型。然后对每种纳入的技术各进行5次操作，并在术中及术后30天对每种技术进行通畅性测试。此外，还根据吻合的淋巴管数量、平均吻合时间和每种技术的难度给出了疗效评分。文献检索共得到148篇文章。总共16篇论文符合方法中定义的纳入标准，并作为“超显微外科淋巴管静脉吻合术技术”纳入综述。疗效评分范围为0.21至1，术中通畅率范围为80%至100%，术后30天通畅性测试范围为60%至100%。为了进行有效的吻合，并力求使超显微外科淋巴管静脉吻合术的效果最大化，现代显微外科医生应接受培训，以识别和处理最常见的血管构型，采用所描述的几种技术中最合适的一种。需要进一步的研究来验证和比较所综述的超显微外科淋巴管静脉吻合术技术的应用。
