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2018/05/23

Immediate Limb Compression Following Supermicrosurgical Lymphaticovenular Anastomosis – Is It Helpful or Harmful?

Video Abstract

Background: Lymphaticovenular anastomosis (LVA) is an established supermicrosurgical treatment of the lymphedema. However, success rates vary, possibly related to the variation in patient selection, surgical technique, and postoperative care. One of the controversies on postoperative care is whether to apply limb compression. We set out to assess the effect of external limb compression on the LVA.
Methods: Following each of the anastomoses of the LVA procedure, the flow across the anastomosis was immediately assessed. A “washout” sign was defined as observing the favorable ante grade, lymph-to-vein flow, whereas a “backflow” sign was defined as observing the unfavorable retrograde, vein-to-lymph flow. After the initial flow pattern was recorded, bandage compression was applied to the leg and the changes to the flow pattern were recorded. Patients were tracked with lymphedema indices as well as lymphedema quality of life (LYMQOL) assessment system at preoperative, within the 3rd and 6th month visits.
Results: Five patients were included in the study. 42 LVAs were constructed - 26 with the standard, and 16 via the octopus technique. Initially, 25 (60%) demonstrated “washout”, with the remaining 17 (40%) showing “backflow”. After compression was applied, those entire initially demonstrating washout” maintained the “washout” pattern, while 16 of 17, or 94%, that initially demonstrated “backflow” converted to “washout”. In the follow up, all patients had statistically significant edema reduction based on lower extremity lymphedema indices (P = 0.0009) and relief of symptoms based on the LYMQOL assessment (P = 0.0006).
Conclusion: Postoperative compression following LVA does not harm the anastomoses created, and can augment the lymphatic flow and convert unfavorable retrograde flow to favorable ante grade flow.

Reference

Wei F. Chen, Mindy Bowen, Johnson Ding. Immediate Limb Compression Following Supermicrosurgical Lymphaticovenular Anastomosis – Is It Helpful or Harmful? International Microsurgery Journal. 2018;2(1):1. DOI: 10.24983/scitemed.imj.2018.00063