9004-562 O’Brien
O'Brien BM, Mellow CG, Khazanchi RK, Dvir E, Kumar V, Pederson WC.
Long-term results after microlymphaticovenous anastomoses for the treatment of
obstructive lymphedema. Plast Reconstr Surg. 1990 Apr;85(4):562-72. PMID: 2315396 [PubMed - indexed for MEDLINE]
Microsurgery Research Centre, St. Vincent's Hospital, Fitzroy, Victoria,
Australia.
Over the last 14 years, 134 patients with obstructive lymphedema have been
treated with microlymphaticovenous anastomoses. Ninety patients were available
for long-term follow-up study. Of these, 52 patients were treated by
microlymphatic surgery only and 38 of them also had segmental or radical
reduction surgery, either at the same time or secondarily. Objective assessment
was undertaken by volume and circumferential measurements. Initially,
lymphangiography was used, but a study demonstrated increased edema immediately
following the investigation in one-third of the patients and it was abandoned,
both preoperatively and postoperatively. In the microlymphaticovenous
anastomoses only group (N = 52), subjective improvement occurred in 38 patients
(73 percent). Objectively, volume changes showed a significant improvement in 22
patients (42 percent), with an average reduction of 44 percent of the excess
volume. In the microlymphaticovenous anastomoses and reduction surgery, usually
segmental, group (N = 38), subjective improvement occurred in 30 patients (78
percent) and objective improvement occurred in 23 patients (60 percent), with an
average reduction of 44 percent of the excess volume. Of those followed up, 67
patients (74 percent) have been able to discontinue the use of conservative
measures, with an average follow-up of 4.0 years and average reduction in excess
volume of 26 percent. There was a 58 percent reduction in the incidence of
cellulitis following surgery. In those patients who were improved, drainage
resulted in increased softness of the limbs. Edema of the hand diminished
considerably in most patients, although this was difficult to measure. These
long-term results indicate that microlymphaticovenous anastomoses have a
valuable place in the treatment of obstructive lymphedema and should be the
treatment of choice in these patients. Reduction surgery can be used as an
adjunct in some of these patients, especially in the posteromedial aspect of the
upper arm. Liposuction has been used in failed cases or in patients in whom no
lymphatics could be found. Improved results can be expected with earlier
operations because patients referred earlier usually have less lymphatic
disruption.
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