Abdominoplasty with Lymphatic Microsurgery for Patients with Secondary Lower Extremity Lymphedema

Comparison of Vectra three-dimensional stereophotogrammetry measurement and tape measurement in the evaluation of perioperative volume change of the lower abdomen in association with lymphatic microsurgery

BACKGROUND

Although microsurgical treatment for lower extremity lymphedema (LEL) can improve lower abdominal morphology, methods to evaluate the volume change of the lower abdomen have yet to be established. This study aimed to determine the accuracy and reproducibility of three-dimensional stereophotogrammetry (3DSM) in measuring the volume change in the lower abdomen.

METHODS

The perioperative volume changes in the lower abdomen were estimated using tape measurement (TM) and 3DSM in 26 patients with LEL. Thirteen patients with suprapubic lymphedema underwent abdominoplasty simultaneously. Each of them underwent multiple lymphaticovenular anastomoses (LVAs), and five of them underwent vascularized lymph node transfer, simultaneously. Thirteen patients with pelvic lymphatic fluid underwent multiple LVAs. Two patients underwent this surgery twice. When assessed on the Internal Society of Lymphology scale, eight patients were Stage I, 10 patients were Stage II, four patients were late Stage II, and four patients were Stage III. The difference between the two measurement methods and reproducibility of each method were analyzed.

RESULTS

During a mean follow-up period of 6 months, all patients had no postoperative complications and their chief complaint improved. The calculated reduction volume between TM and 3DSM showed a high correlation (p < .0001, r = .84). The reduction volume based on TM was significantly larger than 3DSM (991.1 ± 460.3 ml vs. 862.3 ± 333.5 ml, p = .02). The interrater ICC was 0.94 and 0.98 based on TM and 3DSM, respectively.

CONCLUSION

3DSM may be a useful method for assessment of the lower abdominal morphology due to its high accuracy and reproducibility.

Lymphaticovenular anastomosis for Klippel-Trenaunay-Weber syndrome

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To the best of our knowledge, this is the first report on lymphaticovenular anastomosis (LVA) for the Klippel-Trenaunay-Weber syndrome.

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We performed seven LVA procedures for the right lower limb with the intention of preventing recurrent bouts of cellulitis.

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The patient has been cellulitis-free for 1 year post-operatively, having previously had such infection every other month.

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We suggest that LVA may be effective for the management of similar cases.

Introduction

Since we performed lymphaticovenular anastomosis (LVA) for Klippel-Trenaunay-Weber syndrome and obtained relatively good results, we report the adaptation, effect of treatment, and mechanism of LVA.

Presentation of case

Case is a 28-year-old man with an increase of the circumference and pigment changes on the whole right leg and gluteal region from the time he was born. He exhibited signs of right leg cellulitis with a fever about 40° at frequency of the degree once a month. We planned to perform LVA of the right leg to prevent cellulitis of the lower limbs.

Discussion

This case presented with repeated, severe cellulitis occurring once a month prior to treatment. This symptom greatly reduced the quality of life of the patient. Postoperatively, he lived his daily life with no particular limits, and significant improvement quality of life was due to LVA. Therefore, it is inferred that the protective efficacy of inflammation was obtained by anastomosing lymphatics and the vein around the skin lesions and a return current of the lymph flow was promoted.

Conclusion

The possibility that LVA could become an excellent therapy for similar cases is suggested.