Lymphatic Malformation Treated with Lymphatic Malformation–Venous Anastomosis Under Local Anesthesia

Abstract

Summary: Lymphatic malformation (LM) can occur in the head and neck regions and cause cosmetic problems in adults. Sclerotherapy and surgical resection have been frequently applied; however, both are far from being minimally invasive in terms of aesthetic satisfaction, including the aesthetic downtime. We performed a less-invasive treatment using the venous anastomosis technique, named the lymphatic malformation–venous anastomosis (LMVA), mainly in pediatric patients with intractable microcystic lesions, in whom general anesthesia was required because the pediatric patients could not remain still. Here, we report the case of a 35-year-old man with a cystic submandibular LM successfully treated with LMVA under local anesthesia. He presented with a gradually enlarging LM on the neck. For improving aesthetics, LMVA was planned under local anesthesia. Lymphography by injecting indocyanine green revealed no inflow or outflow connection to the malformation; thus, we created an outflow bypass using the sidewall of the LMVA technique. The patient was discharged on the following day of the operation without any postoperative complications. A volumetric analysis 6 months later showed a 43.5% reduction of the malformation, with the patient being completely satisfied with the result. To the best of our knowledge, there has been no previous report on performing LMVA under local anesthesia in an adult. LMVA can be a novel treatment of choice when other options are less feasible.

Surgical management of vascular tumors and malformations of the head and neck in adults

“…Residual or resistant disease can be addressed with surgery. A novel approach has shown early success for intractable LMs using a venous anastomosis technique, named LM–venous anastomosis 11 . Sclerotherapy is also being combined with embolization with fibrin glue for AVMs 12 …”

Combined Treatment with Lymphaticovenular Anastomosis and Ethanol Sclerotherapy for Cystic Lymphatic Malformation Affecting a Limb

“…However, sclerosants cause fibrosis and obliteration of both a lymphocele and a ruptured lymphatic vessel (13), thereby impairing lymphatic drainage, which increases the risk of lymphedema (14)(15)(16). Lymphaticovenular anastomosis (LVA) recently garnered attention in the field of microsurgery as a minimally invasive or prophylactic treatment for lymphedema (17)(18)(19)(20)(21)(22) and cystic lymphatic malformation (23)(24)(25)(26)(27)(28), although its success rate and indications in terms of the size of the lymphocele for which it is most effective remain unclear. Some reports have described combined treatment for lymphocele consisting of surgical excision and LVA for large or persistent lymphoceles (29,30).…”