Background: Lower limb lymphedema (LLL) is a chronic condition with impaired lymphatic drainage. Lymphaticovenular anastomosis (LVA) is a promising microsurgical treatment for LLL. Refined surgical techniques, such as optimal incision placement and precise lymphatic vessel identification, are essential for better clinical outcomes.
Objective: For patients with LLL, perform a lymphaticovenular anastomosis (LVA) via the lymphosome-based four-incision approach. Standardize incision positioning and identify lymphatic vessels for LVA to improve surgical outcomes.
Methods: A retrospective study was conducted on 59 patients with LLL who underwent LVA. Among them, 32 patients in the study group received LVA using the four-incision approach, and 27 patients in the control group underwent LVA with empirically determined incision placement. All patients were followed up for 12 months after the operation. The outcome measures included the number of lymphatic-to-venous anastomoses, surgical duration, Lymphedema Functioning, Disability, and Health Questionnaire for Lower Limb Lymphedema (Lymph-ICF) and Lower Extremity Lymphedema Index (LELI), Patient Health Questionnaire-9 items (PHQ-9) and subcutaneous thickness.
Result: At the 6-month and 12-month follow-ups, there was a significant interaction between the two groups of patients in terms of LELI and lymph-ICF (P < 0.05). The PHQ-9 has observed no interaction between the two groups (P > 0.05). After treatment, the subcutaneous thickness in the study group was lower than that in the control group (P < 0.05). There were no significant differences between the two groups regarding surgical duration and the number of lymphatic-to-venous anastomoses (P > 0.05).
Conclusion: LVA via the lymphosome-based four-incision approach can significantly enhance the quality of life, limb volume, and subcutaneous thickness in patients with LLL. This study presents new incision selection criteria for LVA and underlines the necessity of comprehensively addressing patients' mental health.
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