CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(05): 689-695
DOI: 10.1055/s-0042-1756348
Extremity/Lymphedema: Original Article

Lymphaticovenular Anastomosis: Superficial Venous Anatomical Approach

1   Plastic and Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
1   Plastic and Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
› Author Affiliations


Background Lymphaticovenular anastomosis (LVA) is an effective, functional treatment for limb lymphedema. This study reports an alternative surgical approach to lymphedema treatment without the use of indocyanine green mapping.

Methods A retrospective analysis was performed on 29 consecutive lymphedema patients who underwent LVAs from January 2015 to December 2020, whereby incisions were made along the anatomy of the superficial venous systems in both upper and lower extremities around the joint areas. The evaluation included qualitative assessments and quantitative volumetric analyses.

Result The mean number of anastomoses was 3.07, and the operative time was 159.55 minutes. Symptom improvement was recorded in 86.21% of the patients, with a mean volume reduction of 32.39%. The lymphangitis episodes decreased from 55.17% before surgery to 13.79% after surgery, and the median number of lymphangitis episodes per year decreased from 1 before surgery to 0 after surgery.

Conclusions The superficial venous anatomical approach is an easy way to start a lymphedema practice using LVA without other advanced surgical equipment. With this reliable technique, microsurgeons can perform LVA procedures and achieve good results.

Authors' Contributions

Conceptualization: K.W., P.S. Data curation: K.W. Methodology: K.W., P.S. Project administration: K.W. Writing original draft: K.W. Writing – review & editing: K.W., P.S. All authors read and approved the final manuscript.

Ethical Approval

The study was approved by the Khon Kaen University Ethics Committee for Human Research (IRB No. HE641259) and performed in accordance with the principles of the Declaration of Helsinki. The informed consent was waived because this study design is a retrospective chart review.

Patient Consent

Patients provided written consent for the use of their images.

Publication History

Received: 01 October 2021

Accepted: 26 July 2022

Article published online:
23 September 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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