抄録
Lymphedema is a progressive debilitating edematous disease, which significantly worsens the quality of life of cancer survivors. With the advancement of supermicrosurgery that enables secure anastomosis of vessels with a diameter of 0.5 mm or smaller, lymphatic supermicrosurgery has been developed. Lymphaticovenular anastomosis ( LVA ) is one of the lymphovenous shunt operations. It is the most convenient surgery that addresses the pathophysiology of obstructive lymphedema, but has a risk of thrombosis and is likely to be ineffective for progressive lymphedema with severe lymphosclerosis. To minimize the risk of thrombosis at the anastomosis site, lymphaticolymphatic anastomosis ( LLA ) is useful. LLA can be applied when an intact recipient lymphatic vessel is available, such as in cellulitis-induced lymphedema cases. As well as LVA, LLA is hardly effective for progressed lymphedema. For progressed lymphedema, vascularized lymph node transfer ( LNT ) is useful. Most surgeons perform LVA only with vascular anastomosis, but it is desirable to bypass an efferent lymphatic vessel included in a transferred lymph node flap for complete lymphatic bypass because approximately half of lymph fluid drained into a lymph node flows into the efferent lymphatic vessel. Lymphatic supermicrosurgery allows various lymphatic reconstructions in an optimal way.
