Simplifying Supermicrosurgical End-to-Side Lymphaticovenous Anastomosis Using a Triangular Silicone Background Sheet...

Area of Science:

• Vascular Surgery
• Microsurgery
• Lymphedema Treatment

Background:

• Supermicrosurgical lymphaticovenous anastomosis (LVA) is a key treatment for lymphedema.
• Simultaneous visualization of lymphatic and venous lumens presents a significant technical challenge.

Purpose of the Study:

• To present a novel technique using a triangular silicone background sheet as an inter-vessel spacer to simplify LVA.
• To improve lumen exposure, stability, and anastomotic outcomes in supermicrosurgery.

Main Methods:

• A triangular silicone background sheet is used as an inter-vessel spacer after the initial posterior wall suture.
• The spacer provides controlled, tremor-free exposure of both lumens and allows tension adjustment.
• Strategic positioning optimizes vessel orientation for anastomosis.

Main Results:

• The technique was applied to 503 patients undergoing 3,153 LVAs over nine years.
• It demonstrated effectiveness in end-to-side LVA, facilitating single-surgeon workflow and multiple anastomoses.
• Patency was confirmed post-anastomosis via venous washout or reflux.

Conclusions:

• The triangular background sheet spacer is an inexpensive and effective adjunct for improving lumen exposure and stability during LVA.
• This innovation addresses a critical barrier to reliable anastomotic outcomes in supermicrosurgery.
• The technique enhances the feasibility and success rate of LVA for lymphedema management.