Office-Based Lymphatic Supermicrosurgery: Supermicrosurgical Lymphaticovenular Anastomosis at an Outpatient Clinic

Yamamoto, Takumi; Yamamoto, Naoki

doi:10.1055/s-0042-1750123

Cited by 7 publications

(3 citation statements)

References 40 publications

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“…81 Special attention is given to avoid unnecessary trauma or damage to the lymphatic system. 82,83 Using intraoperative microscopic ICG-L, navigational lymphatic supermicrosurgery enables early identification and dissection of lymphatic vessels, enhancing the success of lymphaticovenular anastomosis procedures. 84 The identification and dissection of a suitable adjacent reflux-free recipient vein is also crucial for successful anastomoses.…”

Section: Surgical Procedures (Dissection/ Preparation Of Lymph/vein A...mentioning

confidence: 99%

Supermicrosurgical lymphovenous anastomosis

Lin,

Yamamoto

2024

Journal of the Chinese Medical Association

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Genital elephantiasis is a severe form of lymphedema of the groin. It is characterized by progressive enlargement and distortion of the genitals, presenting significant physical, psychological, and social challenges to the affected individuals. While pharmacological treatment of filariasis is well-established in the medical field, the surgical management of genital elephantiasis can be varied and confusing. This review article provides an in-depth analysis of the etiology, classification, severity grading, and various effective surgical treatment and reconstructive modalities commonly employed by surgeons since the early 20th Century. We also discuss how a combination approach of ablation, soft tissue coverage, and lymphatic reconstruction is viable for treating genital elephantiasis. By examining the literature, we hope to provide insights into how surgery plays a role in the holistic management of genital elephantiasis.

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Section: Surgical Procedures (Dissection/ Preparation Of Lymph/vein A...mentioning

confidence: 99%

Supermicrosurgical lymphovenous anastomosis

Lin,

Yamamoto

2024

Journal of the Chinese Medical Association

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“…This has the highest patency rate and is characterized by the best dynamics, as all the lymphatic flow is diverted into the venule, avoiding the loss of lymphatic pressure that may characterizes the S-E and S-S anastomoses in which the lymphatic is not interrupted. 24,25 The E-S maintains the whole lymphatic flow but it needs a recipient venule with no backflow to be effective. Most published literature focused on the S-E configuration for the possibility of draining both the anterograde and retrograde lymph flow with a single anastomosis, 6,7 but this may be associated with a poor dynamic.…”

Section: Features Of the Recipient Venulesmentioning

confidence: 99%

Recipient Venule Selection and Anastomosis Configuration for Lymphaticovenular Anastomosis in Extremity Lymphedema: Algorithm Based on 1,000 Lymphaticovenular Anastomosis

Bianchi

Salgarello

Hayashi

et al. 2021

J Reconstr Microsurg

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Background The lymphaticovenular anastomosis (LVA) has three components, lymphatics, venules, and anastomosis, and all of them influence the anastomotic pressure gradient. Although it has been demonstrated that venule flow dynamics has an independent impact on the outcomes regardless the degeneration status of lymphatic vessels, recipient venules (RV) have been mainly neglected in literature. Patients and Methods From January 2016 to February 2020, 232 nonconsecutive patients affected by extremity lymphedema underwent LVA, for a total of 1,000 LVAs. Only patients with normal-to-ectasic lymphatic collectors were included to focus the evaluation on the RV only. The preoperative collected data included the location, diameter, and continence of the selected venules, the expected number, the anastomoses configuration, and their flow dynamics according to BSO classification. Results The 232 patients included 117 upper limb lymphedema (ULL) and 115 lower limb lymphedema (LLL). The average size of RV was 0.81 ± 0.32 mm in end-to-end (E-E), 114 ± 0.17 mm in end-to-side (E-S), 0.39 ± 0.22 mm in side-to-end (S-E), and 0.76 ± 0.38 mm in side-to-side (S-S) anastomoses. According to the BSO classification, on a total of 732 RV, 105(14%) were backflow venules, 136 (19%) were slack, and 491 (67%) were outlet venules. Also, 824 (82%) were E-E, 107 (11%) were E-S, 51 (5%) were S-E, and 18 (2%) were S-S anastomoses. Conclusion Based on 1,000 LVAs with similar lymphatic characteristics, we propose our algorithm that may aid the lymphatic microsurgeon in the selection of RV and the consequent anastomosis configuration, in order of obtain the best flow dynamic through the LVA. This therapeutic study reflects level of evidence IV.

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“…In theory, any flap containing deep adipose tissue can be employed for LIFT. 23 24 25 However, the superficial circumflex iliac artery perforator (SCIP) flap is particularly advantageous as it resides in an area devoid of dominant lymphatic pathways and links to the superficial epigastric lymph nodes. By utilizing this flap, the risk of donor-site lymphedema is minimized, even in the absence of incorporated lymph nodes.…”

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confidence: 99%

Lymphatic Patterns in the Superficial Circumflex Iliac Artery Perforator Flap

Campos,

Suominen,

Pons

et al. 2024

J Reconstr Microsurg

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Background: Lymphedema is a chronic condition, characterized by fluid buildup and tissue swelling and is caused by impairment of the lymphatic system. The lymph interpositional flap transfer (LIFT) technique, in which lymph flow is restored with a flap that includes subdermal lymphatic channels, is an option for surgical reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap can be used for this purpose. This study aimed to describe and characterize the lymphatic patterns within the vascular territory of the superficial circumflex iliac artery perforator flap. Methods: This cross-sectional multicenter study involved 19 healthy volunteers aged ≥18 years of both sexes assessing the bilateral SCIP flap zone. Superficial lymphatic patterns were evaluated at 4-, 14-, and 24-minutes after indocyanine green lymphography (ICG) injection. Standardized procedures were implemented for all participants in both hospitals. Results: The linear pattern was predominant bilaterally. The median number of lymphatic vessels and their length increased over time. Most lymphatic vessels in the superficial circumflex iliac artery perforator flap were oriented towards the inguinal lymph node. However, the left SCIP zone lymphatic vessels were directed opposite to the inguinal lymph node. Conclusion: The two sides SCIP zones were not significantly different. The primary direction of the bilateral lymphatic vessels was towards the inguinal lymph node, although only single side lymphatic vessels were in the opposite direction. These findings emphasize the importance of assessing lymphatic axiality and coherent lymphatic patterns prior to undertaking the SCIP as an interposition flap, to ensure effective restoration of lymphatic flow.

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Office-Based Lymphatic Supermicrosurgery: Supermicrosurgical Lymphaticovenular Anastomosis at an Outpatient Clinic

Cited by 7 publications

References 40 publications

Supermicrosurgical lymphovenous anastomosis

Supermicrosurgical lymphovenous anastomosis

Recipient Venule Selection and Anastomosis Configuration for Lymphaticovenular Anastomosis in Extremity Lymphedema: Algorithm Based on 1,000 Lymphaticovenular Anastomosis

Lymphatic Patterns in the Superficial Circumflex Iliac Artery Perforator Flap

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