Modified lambda-shaped lymphaticovenular anastomosis with supermicrosurgical lymphoplasty technique for a...

Supermicrosurgical lymphaticovenular anastomosis (LVA) has become a useful option for the treatment of compression-refractory lymphedema with its effectiveness and less invasiveness. It is important to make as many bypasses as possible for better treatment results of LVA operation. We report a secondary lymphedema case successfully treated using a modified lambda-shaped LVA. A 62-year-old female with secondary lower extremity lymphedema (LEL) refractory to conservative treatments underwent LVA operation. A modified lambda-shaped LVA was performed at the left groin. In modified lambda-shaped LVA, two lymphatic vessels were transected, and both ends of the proximal and distal sides were converged respectively for an end-to-side and end-to-end anastomoses to one vein. Using modified lambda-shaped LVA, four lymph flows of two lymphatic vessels could be bypassed into a vein. Six months after the LVA surgery, her left LEL index decreased from 261 to 247, indicating edematous volume reduction. Modified lambda-shaped LVA effectively bypasses all lymph flows from two lymphatic vessels, when only one large vein can be found in the surgical field.