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Updated: Oct 16, 2025

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A Systematic Stepwise Method to Perform a Supermicrosurgical Lymphovenous Anastomosis.

Jose R Rodriguez, Takumi Yamamoto1

  • 1From the Department of Plastic and Reconstructive Surgery, National Center for Global Health and Medicine, Tokyo, Japan.

Annals of Plastic Surgery
|October 21, 2021
PubMed
Summary

Supermicrosurgical lymphovenous anastomosis (LVA) offers effective treatment for extremity lymphedema. A systematic 6-step approach improves patient selection, planning, and surgical execution for better outcomes.

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Area of Science:

  • Vascular Surgery
  • Microsurgery
  • Lymphedema Management

Background:

  • Lymphovenous anastomosis (LVA) is a common treatment for extremity lymphedema.
  • Supermicrosurgical techniques are increasingly utilized for LVA.
  • A standardized approach is needed for reproducible results.

Purpose of the Study:

  • To present a systematic strategy for patient selection, preoperative planning, and intraoperative execution of supermicrosurgical LVA.
  • To simplify the LVA procedure for improved reproducibility, particularly for surgeons in early practice.

Main Methods:

  • A review of 229 patients undergoing LVA between January 2015 and June 2018.
  • Prospective data collection with all procedures performed by the senior author.
  • Preoperative assessment using lymphoscintigraphy, ICG lymphography, MR lymphography, and ultrasonography.

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  • A sequential 6-step approach for LVA execution.

    • Main Results:

    • 229 patients underwent 677 LVAs with a median follow-up of 33 months.
    • High lymphatic (100%) and vein (99.7%) detection rates.
    • Significant volume reduction in upper-extremity (100%) and lower-extremity (86.8%) lymphedema.
    • Reduction in cellulitis episodes from 2.1 to 0.2 per year post-LVA (P < 0.05).

    Conclusions:

    • A sequential strategy for supermicrosurgical LVA is effective for secondary extremity lymphedema.
    • The presented stepwise approach simplifies the procedure and aids surgeons in early practice.
    • Acceptable success rates were achieved, highlighting the efficacy of the systematic method.