Abstract
Although lymphedema in the extremities is a troublesome adverse effect following radical resection of various cancers, conventional therapies for lymphedema are not always satisfactory, and new breakthroughs are anticipated. With the introduction of supermicrosurgical techniques for the anastomosis of blood or lymphatic vessels less than 0.8 mm in diameter, we have developed a novel method of lymphaticovenular anastomosis for the treatment of primary as well as secondary lymphedema in the extremities. Here, we review the pathophysiological aspects of lymphedema, emphasizing the importance of smooth-muscle cell function in the affected lymphatic walls. We then describe the theoretical basis and detailed operative techniques of our lymphaticovenular anastomoses. Although technically demanding, especially for beginners, we believe that this method will become a new clinical standard for the treatment of lymphedema in the near future.
Similar content being viewed by others
References
N Thompson (1970) ArticleTitleBuried dermal flap operation for chronic lymphedema of the extremities. Ten-year survey of results in 79 cases Plast Reconstr Surg 45 541–548 Occurrence Handle4910556
I Koshima Y Nanba T Tsutsui et al. (2003) ArticleTitleMedial plantar perforator flaps with supermicrosurgery Clin Plast Surg 30 447–455 Occurrence Handle10.1016/S0094-1298(03)00044-0 Occurrence Handle12916599
I Koshima K Inagawa K Etoh et al. (1999) ArticleTitleSupramicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the extremities (in Japanese) Nippon Geka Gakkai Zasshi (Journal of Japan Surgical Society) 100 551–556
I Koshima K Inagawa K Urushibara et al. (2000) ArticleTitleSupermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities J Reconstr Miscrosurg 16 437–442
I Koshima Y Nanba T Tsutsui et al. (2003) ArticleTitleLong-term follow-up after lymphaticovenular anastomosis for lymphedema in the leg J Reconstr Microsurg 19 209–215 Occurrence Handle10.1055/s-2003-40575 Occurrence Handle12858242
I Koshima Y Nanba T Tsutsui et al. (2004) ArticleTitleMinimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema: is it effective for stage III and IV? Ann Plast Surg 53 261–266 Occurrence Handle10.1097/01.sap.0000120319.89926.07 Occurrence Handle15480014
I Koshima T Higashino N Fukuda et al. (2005) ArticleTitleFunctional and structural characteristics of lymphatic systems and lymphedema (in Japanese) Ensho to Men-eki (Inflammatology and Immunology) 13 426–431
G Oliver (2004) ArticleTitleLymphatic vasculature development Nat Rev Immunol 4 35–45 Occurrence Handle10.1038/nri1258 Occurrence Handle14704766
MJ Karkkainen A Saaristo L Jussila et al. (2001) ArticleTitleA model for gene therapy of human hereditary lymphedema Proc Natl Acad Sci U S A 98 12 677–12 682 Occurrence Handle10.1073/pnas.221449198
RE Ferrell (2002) ArticleTitleResearch perspectives in inherited lymphatic disease Ann N Y Acad Sci 979 39–51 Occurrence Handle12543715
SJ Mandriota L Jussila M Jeltsch et al. (2001) ArticleTitleVascular endothelial growth factor-C-mediated lymphangiogenesis promotes tumour metastasis EMBO J 20 672–682 Occurrence Handle10.1093/emboj/20.4.672 Occurrence Handle11179212
M Skobe T Hawighorst DG Jackson et al. (2001) ArticleTitleInduction of tumor lymphangiogenesis by VEGF-C promotes breast cancer metastasis Nat Med 7 192–198 Occurrence Handle10.1038/84643 Occurrence Handle11175850
JT Wigle N Harvey M Detmar et al. (2002) ArticleTitleAn essential role for Prox1 in the induction of the lymphatic endothelial cell phenotype EMBO J 21 1505–1513 Occurrence Handle10.1093/emboj/21.7.1505 Occurrence Handle11927535
M Földi (1984) Lymphedema NC Straub PS Mortimer (Eds) Edema Raven New York
I Koshima S Kawada T Moriguchi et al. (1996) ArticleTitleUltrastructural observations of lymphatic vessels in lymphedema in human extremities Plast Reconstr Surg 97 397–405 Occurrence Handle8559823
C Campisi F Boccardo A Zilli et al. (2001) ArticleTitleLong-term results after lymphatic-venous anastomoses for the treatment of obstructive lymphedema Microsurgery 21 135–139 Occurrence Handle10.1002/micr.1025 Occurrence Handle11494379
BM O'Brien WA Morrison (1987) Microlymphatic surgery, reconstructive microsurgery Churchill-Livingstone Edinburgh 485–505
DG Bichet (1992) Renal sodium excretion, edematous disorders, and diuretic use RW Schrier (Eds) Renal and electrolyte disorders Little, Brown and Company Boston
I Koshima K Inagawa K Urushibara et al. (1998) ArticleTitleEtiology and symptoms of 35 cases with lymphedema in lower extremity: transition from unilateral into bilateral lymphedema (in Japanese) Nippon Keiseigeka Gakkai Zasshi (Journal of Japan Society of Plastic and Reconstructive Surgery) 18 138–143
L Clodius (1990) Lymphedema JG McCarthy (Eds) Plastic surgery, vol. 6. The trunk and lower extremity Saunders Philadelphia 4093–4101
JB Kinmonth PA Hurst JM Edwards et al. (1978) ArticleTitleRelief of lymph obstruction by use of a bridge of mesentery and ileum Br J Surg 65 829–833 Occurrence Handle737415
BM O'Brien LA Chait PJ Hurwitz (1977) ArticleTitleMicrolymphatic surgery Orthop Clin North Am 8 405–424 Occurrence Handle896169
BM O'Brien CG Mellow RK Khazanchi et al. (1990) ArticleTitleLong-term results after microlymphaticovenous anastomoses for the treatment of obstructive lymphedema Plast Reconstr Surg 85 562–572 Occurrence Handle2315396
RG Baumeister S Siuda (1990) ArticleTitleTreatment of lymphedemas by microsurgical lymphatic grafting: what is proved? Plast Reconstr Surg 85 64–74 Occurrence Handle2293739
RG Baumeister S Siuda H Bohmert et al. (1986) ArticleTitleA microsurgical method for reconstruction of interrupted lymphatic pathways: autologous lymph-vessel transplantation for treatment of lymphedemas Scand J Plast Reconstr Surg 20 141–146 Occurrence Handle3775285
YS Yoon T Murayama E Gravereaux et al. (2003) ArticleTitleVEGF-C gene therapy augments postnatal lymphangiogenesis and ameliorates secondary lymphedema J Clin Invest 111 717–725 Occurrence Handle10.1172/JCI200315830 Occurrence Handle12618526
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Nagase, T., Gonda, K., Inoue, K. et al. Treatment of lymphedema with lymphaticovenular anastomoses. Int J Clin Oncol 10, 304–310 (2005). https://doi.org/10.1007/s10147-005-0518-5
Received:
Issue Date:
DOI: https://doi.org/10.1007/s10147-005-0518-5