PMID- 27348659
OWN - NLM
STAT- MEDLINE
DCOM- 20170425
LR  - 20220419
IS  - 1529-4242 (Electronic)
IS  - 0032-1052 (Linking)
VI  - 138
IP  - 1
DP  - 2016 Jul
TI  - Multisite Lymphaticovenular Bypass Using Supermicrosurgery Technique for 
      Lymphedema Management in Lower Lymphedema Cases.
PG  - 262-272
LID - 10.1097/PRS.0000000000002254 [doi]
AB  - BACKGROUND: The impact of lymphaticovenous anastomosis on lymphedema has yet to 
      be defined. The authors investigated the clinical evidence regarding the 
      effectiveness of lymphaticovenous anastomosis in lower limb lymphedema. METHODS: 
      Eighty-four patients (162 limbs; 73 female and 11 male patients) with lower limb 
      lymphedema who underwent multisite lymphaticovenous anastomosis in the authors' 
      clinic between August of 2010 and May of 2014 were included in this retrospective 
      study. Lymphedema was diagnosed using lymphoscintigraphy and indocyanine green 
      lymphography. All lymphaticovenous anastomoses were performed under local 
      anesthesia. The lymphatic vessels that were identified were classified using the 
      normal, ectasis, contraction, and sclerosis type (NECST) classification. Limb 
      circumference, subjective symptoms, and frequency of cellulitis were evaluated. 
      RESULTS: The average patient age was 60 years (range, 24 to 94 years); mean 
      postoperative follow-up period was 18.3 months (range, 6 to 51 months). The 
      postoperative change rate in limb circumference indicated that 67 limbs (47.7 
      percent) were classified as improved, 35 (27.3 percent) were classified as 
      stable, and 32 (25 percent) were classified as worse. Postoperative interview 
      revealed improvement in subjective symptoms in 67 limbs (61.5 percent), no change 
      in 38 (34.9 percent), and exacerbation in four (3.7 percent). The postoperative 
      mean occurrence of cellulitis was decreased to 0.13 times per year compared with 
      0.89 preoperatively, which was statistically significant (p = 0.00084). Multiple 
      regression analysis using the postanastomosis limb circumference and NECST 
      classification confirmed the following results: change rate (percent) = -0.40 + 
      (0.30 x N) + (-0.84 x E) + (0.22 x C) + (-0.61 x S). CONCLUSION: Lymphaticovenous 
      anastomosis is effective for lower limb lymphedema, in point of limb 
      circumference, subjective symptoms, and the frequency of cellulitis. CLINCAL 
      QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
FAU - Mihara, Makoto
AU  - Mihara M
AD  - Saitama, Tokyo, and Chiba, Japan.
AD  - From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi 
      General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the 
      Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic 
      and Reconstructive Surgery and the Graduate School of Medicine, University of 
      Tokyo.
FAU - Hara, Hisako
AU  - Hara H
AD  - Saitama, Tokyo, and Chiba, Japan.
AD  - From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi 
      General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the 
      Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic 
      and Reconstructive Surgery and the Graduate School of Medicine, University of 
      Tokyo.
FAU - Tange, Shuichi
AU  - Tange S
AD  - Saitama, Tokyo, and Chiba, Japan.
AD  - From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi 
      General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the 
      Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic 
      and Reconstructive Surgery and the Graduate School of Medicine, University of 
      Tokyo.
FAU - Zhou, Han Peng
AU  - Zhou HP
AD  - Saitama, Tokyo, and Chiba, Japan.
AD  - From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi 
      General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the 
      Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic 
      and Reconstructive Surgery and the Graduate School of Medicine, University of 
      Tokyo.
FAU - Kawahara, Mari
AU  - Kawahara M
AD  - Saitama, Tokyo, and Chiba, Japan.
AD  - From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi 
      General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the 
      Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic 
      and Reconstructive Surgery and the Graduate School of Medicine, University of 
      Tokyo.
FAU - Shimizu, Yohei
AU  - Shimizu Y
AD  - Saitama, Tokyo, and Chiba, Japan.
AD  - From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi 
      General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the 
      Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic 
      and Reconstructive Surgery and the Graduate School of Medicine, University of 
      Tokyo.
FAU - Murai, Noriyuki
AU  - Murai N
AD  - Saitama, Tokyo, and Chiba, Japan.
AD  - From the Department of Lymphaic and Reconstructive Surgery, Saiseikai Kawaguchi 
      General Hospital; the Department of Plastic Surgery, Tokyo Takanawa Hospital; the 
      Department of Plastic Surgery, Nadogaya Hospital; and the Department of Plastic 
      and Reconstructive Surgery and the Graduate School of Medicine, University of 
      Tokyo.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Plast Reconstr Surg
JT  - Plastic and reconstructive surgery
JID - 1306050
RN  - 0 (Coloring Agents)
RN  - IX6J1063HV (Indocyanine Green)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Anastomosis, Surgical/methods
MH  - Coloring Agents/pharmacology
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Indocyanine Green/pharmacology
MH  - Lower Extremity/*surgery
MH  - Lymphatic Vessels/diagnostic imaging/*surgery
MH  - Lymphedema/diagnosis/*surgery
MH  - Lymphography/methods
MH  - Lymphoscintigraphy
MH  - Male
MH  - Microsurgery/*methods
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Vascular Surgical Procedures/*methods
MH  - Young Adult
EDAT- 2016/06/28 06:00
MHDA- 2017/04/26 06:00
CRDT- 2016/06/28 06:00
PHST- 2016/06/28 06:00 [entrez]
PHST- 2016/06/28 06:00 [pubmed]
PHST- 2017/04/26 06:00 [medline]
AID - 00006534-201607000-00045 [pii]
AID - 10.1097/PRS.0000000000002254 [doi]
PST - ppublish
SO  - Plast Reconstr Surg. 2016 Jul;138(1):262-272. doi: 10.1097/PRS.0000000000002254.