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J Reconstr Microsurg
DOI: 10.1055/a-2803-4594
Original Article

Systemic Elimination Rather than Redistribution: Segmental Body Water Analysis after Leg Lymphovenous Anastomosis

Authors

  • Yuto Kinjo

    1   Division of Plastic and Aesthetic Surgery, Ina Central Hospital, Ina, Nagano, Japan
    2   Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan

  • Yoshichika Yasunaga 

    3   Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan

  • Shoji Kondoh

    1   Division of Plastic and Aesthetic Surgery, Ina Central Hospital, Ina, Nagano, Japan

  • Saeko Kondoh

    4   Nursing Division, Ina Central Hospital, Ina, Nagano, Japan

  • Masato Umeda

    1   Division of Plastic and Aesthetic Surgery, Ina Central Hospital, Ina, Nagano, Japan

  • Shunsuke Yuzuriha

    2   Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Abstract

Background

Lymphovenous anastomosis (LVA) is a microsurgical procedure that redirects stagnant lymph flow into the venous circulation, reducing fluid stasis in patients with secondary limb lymphedema. Although previous studies have reported that complex decongestive therapy redistributes fluid from the affected leg to other body segments, whether fluid reduction after LVA results from systemic elimination or intersegmental redistribution remains unclear. This study aimed to clarify the mechanism by analyzing the changes in segmental body water (SBW) volume using bioelectrical impedance analysis (BIA).

Methods

We retrospectively analyzed the data of 40 Japanese women with unilateral stage II secondary leg lymphedema who underwent LVA from 2013 to 2021. Multifrequency segmental BIA was used to assess extracellular water, intracellular water, and SBW in the legs, trunk, and arms. Measurements were performed preoperatively and at least 12 months postoperatively. Changes in segmental and total body water (TBW) were statistically evaluated.

Results

Significant reductions were observed in SBW in the affected leg, and in the TBW (affected leg: 5.80–5.20 L, p < 0.001; TBW: 25.6–25.0 L, p = 0.002), with no significant changes in the unaffected leg, trunk, or arms. Extracellular and intracellular water in the affected leg decreased significantly (p = 0.001 and p < 0.001, respectively), whereas the percentage of extracellular water remained stable.

Conclusion

LVA achieved sustained reductions in segmental and TBW volumes, localized to the affected leg, without compensatory increases in other body segments. These findings support the efficacy of leg LVA in achieving long-term fluid homeostasis through systemic elimination of excess lymphatic fluid rather than redistribution.

Keywords

lymphovenous anastomosis - bioelectrical impedance analysis - leg lymphedema - segmental body water

Data Availability Statement

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.




Publication History

Received: 29 June 2025

Accepted: 01 February 2026

Accepted Manuscript online:
06 February 2026

Article published online:
18 February 2026

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