Factors affecting outcomes after supermicrosurgical lymphovenous anastomosis in a defined patient population

Issue title: Selected papers of the 38th Conference of the German Society for Clinical Microcirculation and Hemorheology, 21-23 November 2019, Braunschweig, Germany

Guest editors: P. Wiggermann, A. Krüger-Genge and F. Jung

Article type: Research Article

Authors: Klingelhoefer, Eric^{a; 1} | Hesse, Karl^{a; 1} | Taeger, Christian D.^b | Prantl, Lukas^b | Stepniewski, Adam^a | Felmerer, Gunther^{a; *}

Affiliations: [a] Division of Plastic Surgery, Department of Trauma Surgery, Orthopedics and Plastic Surgery, University Medical Center Goettingen, Germany | [b] Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany

Correspondence: [*] Corresponding author: Gunther Felmerer, MD, Department of Trauma Surgery, Division of Plastic Surgery, Orthopaedics and Plastic Surgery, University Medical Centre Goettingen, Goettingen, Germany. Tel.: +49 1605055255; E-mail: [email protected].

Note: [1] These authors contributed equally to this paper.

Abstract: BACKGROUND:The optimal surgical treatment for lymphedema is still subject of intensive research. Therefore, it is vital to investigate what significance lymphovenous anastomosis (LVA) has in this context. OBJECTIVE:This study aims to determine the short- and long-term results as well as the most important factors that can improve outcomes after LVA. METHODS:This study includes a complete data set of 26 patients who received LVA for a therapy-resistant lymphedema. Patients were followed up for an average of 23 months. RESULTS:50% of the patients reported a subjective improvement. Without conservative treatment after the operation the patients showed significant better results (100% vs. 40.9%, p = 0.030). The localization of lymphedema as well as the region of LVA had a significant influence. In patients with lymphedema affecting the entire leg, symptom improvement was significantly lower (35.3% vs. 77.8%, p = 0.039). Patients who received LVA in an upper limb show a significantly higher improvement in symptoms than patients who received LVA in a lower limb (100% vs. 30%, p = 0.021). CONCLUSIONS:We identified factors with a significant influence on the outcome of patients after receiving LVA. Patients with early-stage upper extremity lymphedema seem to benefit most from this procedure.

Keywords: Lymphedema surgery, lymphovenous anastomosis, microsurgery, results, postoperative care

DOI: 10.3233/CH-199213

Journal: Clinical Hemorheology and Microcirculation, vol. 73, no. 1, pp. 53-63, 2019