Abstract
Background Collecting lymphatics have lymph-drainage function with contraction of smooth muscle
cells. Patients with edema have lost this drainage function due to degeneration of
smooth muscle cells. Lymphaticovenular (LV) anastomosis salvages smooth muscle cells
from reversible degeneration (mild edema), but muscle cells cannot be recovered from
irreversible degeneration (severe edema). Therefore, in severe edema, LV anastomoses
cannot reestablish the drainage function of the lymphatic system.
To overcome this weakness of LV bypass methods for severe edema, new methods were
instituted for repair of this missing drainage function using a lymphadiposal flap
from the contralateral foot for hemilateral edema, or transfer of lateral thoracic
lymph nodes for bilateral edema.
Methods A total of 13 cases were repaired with lymphadiposal flaps and additional LV anastomoses.
These cases have frequent phlegmon or cellulitis or resisted to previous LV anastomoses
and/or compression therapy. The ages ranged from 15 to 75 years. There were four cases
of primary edema and nine cases of secondary edema.
Results Regarding the lymphadiposal flap (n = 8), three cases showed an excellent response (37.5%; no need for compression therapy),
four cases had a good response (50%; improvement with compression), one case showed
no change (12.5%; no improvement), and there were no cases of deterioration. Regarding
the lateral thoracic lymph nodes transfer (n = 5), two cases had a good response (40%), three showed no improvement (60%), and
there were no cases of deterioration.
Conclusion It is concluded that lymphadiposal flap or lymph nodes transfer is suitable for severe
edema having frequent cellulitis in unilateral or bilateral lower extremities resisting
previous LV anastomoses and/or compression therapy.
Keywords
lymph node transfer - lymphedema - lymphadiposal flap
