Abstract: Optimal Sites for Supermicrosurgical Lymphaticovenular Anastomosis: An Analysis of 1259 Anastomoses
Identifieur interne : 001D97 ( Pmc/Corpus ); précédent : 001D96; suivant : 001D98Abstract: Optimal Sites for Supermicrosurgical Lymphaticovenular Anastomosis: An Analysis of 1259 Anastomoses
Auteurs : Takumi Yamamoto ; Nana Yamamoto ; Mitsunaga Narushima ; Isao KoshimaSource :
- Plastic and Reconstructive Surgery Global Open [ 2169-7574 ] ; 2016.
Url:
DOI: 10.1097/01.GOX.0000503086.81128.39
PubMed: NONE
PubMed Central: 5147255
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Abstract: Optimal Sites for Supermicrosurgical Lymphaticovenular Anastomosis: An Analysis of 1259 Anastomoses</title><author><name sortKey="Yamamoto, Takumi" sort="Yamamoto, Takumi" uniqKey="Yamamoto T" first="Takumi" last="Yamamoto">Takumi Yamamoto</name></author><author><name sortKey="Yamamoto, Nana" sort="Yamamoto, Nana" uniqKey="Yamamoto N" first="Nana" last="Yamamoto">Nana Yamamoto</name></author><author><name sortKey="Narushima, Mitsunaga" sort="Narushima, Mitsunaga" uniqKey="Narushima M" first="Mitsunaga" last="Narushima">Mitsunaga Narushima</name></author><author><name sortKey="Koshima, Isao" sort="Koshima, Isao" uniqKey="Koshima I" first="Isao" last="Koshima">Isao Koshima</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmc">5147255</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5147255</idno><idno type="RBID">PMC:5147255</idno><idno type="doi">10.1097/01.GOX.0000503086.81128.39</idno><idno type="pmid">NONE</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">001D97</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001D97</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Abstract: Optimal Sites for Supermicrosurgical Lymphaticovenular Anastomosis: An Analysis of 1259 Anastomoses</title><author><name sortKey="Yamamoto, Takumi" sort="Yamamoto, Takumi" uniqKey="Yamamoto T" first="Takumi" last="Yamamoto">Takumi Yamamoto</name></author><author><name sortKey="Yamamoto, Nana" sort="Yamamoto, Nana" uniqKey="Yamamoto N" first="Nana" last="Yamamoto">Nana Yamamoto</name></author><author><name sortKey="Narushima, Mitsunaga" sort="Narushima, Mitsunaga" uniqKey="Narushima M" first="Mitsunaga" last="Narushima">Mitsunaga Narushima</name></author><author><name sortKey="Koshima, Isao" sort="Koshima, Isao" uniqKey="Koshima I" first="Isao" last="Koshima">Isao Koshima</name></author></analytic><series><title level="j">Plastic and Reconstructive Surgery Global Open</title><idno type="eISSN">2169-7574</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader></TEI><pmc article-type="abstract"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Plast Reconstr Surg Glob Open</journal-id><journal-id journal-id-type="iso-abbrev">Plast Reconstr Surg Glob Open</journal-id><journal-id journal-id-type="publisher-id">GOX</journal-id><journal-title-group><journal-title>Plastic and Reconstructive Surgery Global Open</journal-title></journal-title-group><issn pub-type="epub">2169-7574</issn><publisher><publisher-name>Wolters Kluwer Health</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmc">5147255</article-id><article-id pub-id-type="art-access-id">00235</article-id><article-id pub-id-type="doi">10.1097/01.GOX.0000503086.81128.39</article-id><article-categories><subj-group subj-group-type="heading"><subject>Monday, September 26</subject><subj-group><subject>Reconstructive Session 3</subject></subj-group></subj-group></article-categories><title-group><article-title>Abstract: Optimal Sites for Supermicrosurgical Lymphaticovenular Anastomosis: An Analysis of 1259 Anastomoses</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Yamamoto</surname><given-names>Takumi</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Yamamoto</surname><given-names>Nana</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Narushima</surname><given-names>Mitsunaga</given-names></name><degrees>MD</degrees></contrib><contrib contrib-type="author"><name><surname>Koshima</surname><given-names>Isao</given-names></name><degrees>MD</degrees></contrib></contrib-group><pub-date pub-type="collection"><month>9</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>16</day><month>9</month><year>2016</year></pub-date><volume>4</volume><issue>9 Suppl</issue><supplement>PSTM 2016 Abstract Supplement</supplement><elocation-id>152-152</elocation-id><permissions><copyright-statement>Copyright © 2016 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access"><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND)</ext-link>, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.</license-p></license></permissions><self-uri xlink:type="simple" xlink:href="gox-4-152a.pdf"></self-uri><custom-meta-group><custom-meta><meta-name>OPEN-ACCESS</meta-name><meta-value>TRUE</meta-value></custom-meta></custom-meta-group></article-meta></front><body><p><bold>BACKGROUND:</bold> With establishment of supermicrosurgery (microvascular anastomosis of 0.5 mm vessel), supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming a choice of treatment for compression-refractory lymphedema.<sup>1,2</sup> It is important to anastomose a lymphatic vessel with abundant lymph flow for effective bypass.<sup>2,3</sup> However, optimal site for LVA is yet to be clarified.</p><p><bold>METHODS:</bold> LVA was performed on 264 limbs of 134 lower extremity lymphedema (LEL) patients. Intraoperative lymphatic vessel’s findings were assessed according to characteristics of limbs, and preoperative indocyanine green (ICG) lymphography findings.<sup>4,5</sup> Univariate and multivariate analyses were performed to clarify factors associated with lymphatic vessel’s diameter and lymphosclerosis.</p><p><bold>RESULTS:</bold> LVA resulted in 1259 anastomoses using 949 lymphatic vessels at 794 surgical sites. The number of anastomoses per limb ranged from 1 to 16 (median 5). Multivariate analyses revealed that factors associated with larger lymphatic vessel (0.5 mm or larger) were age [65 or older; odds ratio (OR) 1.403], radiation history (OR 1.622), incision in thigh/leg (compared with groin; OR 1.607/1.628), and ICG lymphography of Stardust/Diffuse pattern (compared with Linear pattern; OR 0.529/0.047), and that factors associated with severe lymphosclerosis were body mass index (25 or larger; OR 1.775), radiation history (OR 0.465), incision in thigh/foot (OR 2.378/4.444), and ICG lymphography of Stardust/Diffuse pattern (OR 82.048/1406.174).</p><p><bold>CONCLUSIONS:</bold> Factors associated with lymphatic vessel’s diameter and sclerosis were clarified. It is important to put an incision for LVA in regions with higher probability to find a large lymphatic vessel with less lymphosclerosis. ICG lymphography finding is the most important preoperative indicator to predict lymphatic vessel’s condition, and LVA should not be performed in regions with Diffuse pattern.</p><p><bold><italic>DISCLOSURE/FINANCIAL SUPPORT:</italic></bold><italic>Supported, in part, by Tokyo Metropolitan Clinical Research Grant for Special Research H280402001 (to Dr. Takumi Yamamoto). None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript</italic>.</p><p><bold>REFERENCES:</bold></p><p>1. Yamamoto T, Narushima M, Yoshimatsu H, Seki Y, Yamamoto N, Oka A, et al. Minimally invasive lymphatic supermicrosurgery (MILS): indocyanine green lymphography-guided simultaneous multi-site lymphaticovenular anastomoses via millimeter skin incisions. Ann Plast Surg. 2014;72(1):67–70.</p><p>2. Yamamoto T, Narushima M, Kikuchi K, Yoshimatsu H, Todokoro T, Mihara M, et al. Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis. Plast Reconstr Surg 2011;127(5):1987–92.</p><p>3. Yamamoto T, Yamamoto N, Azuma S, Yoshimatsu H, Seki Y, Narushima M, et al. Near-infrared illumination system-integrated microscope for supermicrosurgical lymphaticovenular anastomosis. Microsurgery 2014;34(1):23–7.</p><p>4. Yamamoto T, Narushima M, Doi K, Oshima A, Ogata F, Mihara M, et al. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011;127(5):1979–86.</p><p>5. Yamamoto T, Matsuda N, Doi K, Oshima A, Yoshimatsu H, Todokoro T, et al. The earliest finding of indocyanine green (ICG) lymphography in asymptomatic limbs of lower extremity lymphedema patients secondary to cancer treatment: the modified dermal backflow (DB) stage and concept of subclinical lymphedema. 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