Size adjustment suture technique for lymphaticovenular anastomosis
DOI:
https://doi.org/10.2340/jphs.v58.18384Keywords:
Lymphaticovenous anastomosis, super-microsurgery, caliber difference, long-term patency, obstructionAbstract
In this report, we describe a super microsurgical technique that enables rapid and accurate anastomosis while adjusting for caliber differences when anastomosing a small-caliber lymphatic vessel and a vein with a larger caliber, which is frequently encountered in surgeries such as lymphaticovenous anastomosis (LVA).
The suture size adjustment technique was performed in 30 anastomoses of lymphatic vessels and veins, whose diameter of lymph duct was at least two times smaller than that of the vein. The type of lymphedema, caliber of lymphatic vessels and veins anastomosed, caliber ratio, vein wall thickness, modified caliber ratio after vein wall thickness subtracted, presence of additional anastomosis, and anastomosis time were examined. On average, the lymphatic vessels had a diameter of 0.61 mm, while the veins were 1.43 mm in diameter. The mean caliber ratio of vein to lymphatic vessel was 2.3, while the modified caliber ratio of vein-to-lymphatic vessel was 1.5 on average. The average venous wall thickness was 0.51. The average anastomosis time was 9.1 min and no additional anastomosis due to leakage was necessary in any case.
We successfully performed an anastomosis of lymphatic vessels and veins with different calibers, which can maintain long-term patency while adjusting the caliber difference and suppressing leakage at the anastomosis site. Finally, the caliber of the vein is commonly larger than that of the lymphatic vessel to be anastomosed in many cases of LVA surgery, indicating that the proposed anastomosis method could be of therapeutic use in many cases.
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References
Chang DW. Lymphaticovenular bypass for lymphedema management in breast cancer patients: a prospective study. Plast Reconstr Surg. 2010 Sep; 126(3): 752–758. https://doi.org/10.1097/PRS.0b013e3181e5f6a9 DOI: https://doi.org/10.1097/PRS.0b013e3181e5f6a9
Olszewski WL. Lymphovenous microsurgical shunts in treatment of lymphedema of lower limbs: a 45-year experience of one surgeon/one center. Eur J Vasc Endovasc Surg. 2013 Mar; 45(3): 282–290. https://doi.org/10.1016/j.ejvs.2012.11.025 DOI: https://doi.org/10.1016/j.ejvs.2012.11.025
Campisi C, Boccardo F, Zilli A, et al. Long-term results after lymphatic-venous anastomoses for the treatment of obstructive lymphedema. Microsurgery. 2001; 21: 135–139. https://doi.org/10.1002/micr.1025 DOI: https://doi.org/10.1002/micr.1025
Onoda S, Masahito K. The utility of the airborne technique for lymphaticovenular anastomosis. Plast Reconstr Surg. 2019 Feb; 143(2): 459e–460e. https://doi.org/10.1097/PRS.0000000000005251 DOI: https://doi.org/10.1097/PRS.0000000000005251
Onoda S, Komagoe S. Lymphaticovenular anastomosis for Klippel–Trenaunay–Weber syndrome. Int J Surg Case Rep. 2019; 58: 67–69. https://doi.org/10.1016/j.ijscr.2019.04.023 DOI: https://doi.org/10.1016/j.ijscr.2019.04.023
Onoda S, Kinoshita M. Involved stich technique for super-microsurgical anastomosis. J Plast Reconstr Aesthet Surg. 2020 Jun; 73(6): 1174–1205. https://doi.org/10.1016/j.bjps.2020.02.013 DOI: https://doi.org/10.1016/j.bjps.2020.02.013
Nguyen AT, Chang EI, Suami H, et al. An algorithmic approach to simultaneous vascularized lymph node transfer with microvascular breast reconstruction. Ann Surg Oncol. 2015 Sep; 22(9): 2919–2924. https://doi.org/10.1245/s10434-015-4408-4 DOI: https://doi.org/10.1245/s10434-015-4408-4
Hunter CL, Chang DW. Discussion: anatomical basis of the gastroepiploic vascularized lymph node transfer: a radiographic evaluation using computed tomographic angiography. Plast Reconstr Surg. 2018 Oct; 142(4): 1053–1054. https://doi.org/10.1097/PRS.0000000000004796 DOI: https://doi.org/10.1097/PRS.0000000000004796
Roka-Palkovits J, Steinbacher J, Tinhofer I, et al. Treatment of cervicofacial lymphatico-venous malformation with vascularized lymph node transfer (VLNT). Plast Reconstr Surg. 2018 Sept; 142(3): 425e–426e. https://doi.org/10.1097/PRS.0000000000004628 DOI: https://doi.org/10.1097/PRS.0000000000004628
Brorson H, Ohlin K, Olsson G, et al. Quality of life following liposuction and conservative treatment of arm lymphedema. Lymphology. 2006 Mar; 39(1): 8–25.
Brorson H. Liposuction in lymphedema treatment. J Reconstr Microsurg. 2016 Jan; 32(1): 56–65. https://doi.org/10.1055/s-0035-1549158 DOI: https://doi.org/10.1055/s-0035-1549158
Brorson H. From lymph to fat: liposuction as a treatment for complete reduction of lymphedema. Int J Low Extrem Wounds. 2012 Mar; 11(1): 10–19. https://doi.org/10.1177/1534734612438550 DOI: https://doi.org/10.1177/1534734612438550
Onoda S, Nishimon K. The utility of surgical and conservative combination therapy for advanced stage lymphedema. J Vasc Surg Venous Lymphat Disord. 2021 Jan; 9(1): 234–241. https://doi.org/10.1016/j.jvsv.2020.05.007 DOI: https://doi.org/10.1016/j.jvsv.2020.05.007
Boccardo F, Casabona F, De Cian F, et al. Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy. Ann Surg Oncol. 2009 Mar; 16(3): 703–708. https://doi.org/10.1245/s10434-008-0270-y DOI: https://doi.org/10.1245/s10434-008-0270-y
Todokoro T, Furniss D, Oda K, et al. Effective treatment of pelvic lymphocele by lymphaticovenular anastomosis. Gynecol Oncol. 2013 Feb; 128(2): 209–214. https://doi.org/10.1016/j.ygyno.2012.11.014 DOI: https://doi.org/10.1016/j.ygyno.2012.11.014
Onoda S, Kinoshita M. Lymphaticovenular anastomosis in elderly patients. J Plast Reconstr Aesthet Surg. 2020 Jun; 73(6): 1174–1205. https://doi.org/10.1016/j.bjps.2020.02.022 DOI: https://doi.org/10.1016/j.bjps.2020.02.022
Onoda S, Todokoro T, Hara H, et al. Minimally invasive multiple lymphaticovenular anastomosis at the ankle for the prevention of lower leg lymphedema. Microsurgery. 2014 Jul; 34(5): 372–376. https://doi.org/10.1002/micr.22204 DOI: https://doi.org/10.1002/micr.22204
Onoda S, Kimata Y, Matsumoto K. A novel lymphaticovenular anastomosis rat model. Ann Plast Surg. 2016 Mar; 76(3): 332–335. https://doi.org/10.1097/SAP.0000000000000571 DOI: https://doi.org/10.1097/SAP.0000000000000571
Onoda S, Kimata Y, Matsumoto K, et al. Histologic evaluation of lymphaticovenular anastomosis outcomes in the rat experimental model: comparison of cases with patency and obstruction. Plast Reconstr Surg. 2016 Jan; 137(1): 83e–91e. https://doi.org/10.1097/PRS.0000000000001884 DOI: https://doi.org/10.1097/PRS.0000000000001884
Onoda S, Kimata Y, Sugiyama N, et al. Analysis of 10-year training results of medical students using the Microvascular Research Center Training Program. J Reconstr Microsurg. 2016 Jun; 32(5): 336–341. https://doi.org/10.1055/s-0035-1568884 DOI: https://doi.org/10.1055/s-0035-1568884
Onoda S, Kimata Y, Goto A. The drop-down technique as an optimal technique for back-wall end-to-side anastomosis. J Craniofac Surg. 2014 Jul; 25(4): 1435–1437. https://doi.org/10.1097/SCS.0000000000000754 DOI: https://doi.org/10.1097/SCS.0000000000000754
Onoda S, Sakuraba M, Asano T, et al. Thoracoacromial vessels as recipients for head and neck reconstruction and cause of vascular complications. Microsurgery. 2011 Nov; 31(8): 628–631. https://doi.org/10.1002/micr.20947 DOI: https://doi.org/10.1002/micr.20947
Visconti G, Salgarello M, Hayashi A. The recipient venule in supermicrosurgical lymphaticovenular anastomosis: flow dynamic classification and correlation with surgical outcomes. J Reconstr Microsurg. 2018 Oct; 34(8): 581–589. https://doi.org/10.1055/s-0038-1649518 DOI: https://doi.org/10.1055/s-0038-1649518
Hayashi A, Visconti G. Supermicrosurgical lymphaticovenular anastomosis: a practical textbook. Morrisville, North Carolina, United States: lulu.com. 2020 HV Editions.
Onoda S, Kimata Y, Matsumoto K. Iliolumbar vein as a training model for microsurgical end-to-side anastomosis. J Craniofac Surg. 2016 May; 27(3): 767–768. https://doi.org/10.1097/SCS.0000000000002501 DOI: https://doi.org/10.1097/SCS.0000000000002501
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