Journal of Plastic, Reconstructive & Aesthetic Surgery
Complete lymph flow reconstruction: A free vascularized lymph node true perforator flap transfer with efferent lymphaticolymphatic anastomosis☆
Section snippets
Case report
A 49-year-old female had suffered from idiopathic left lower extremity edema for the past 5 years. Edema began at the age of 44 years without any causative episode and since then had gradually worsened. The patient experienced frequent episodes of left leg cellulitis since she was 45 years old. She was not under medication and had no medical history or family history of edematous diseases. Heart failure, nephrosis, liver cirrhosis, deep venous thrombosis, varix, endocrine diseases,
Discussion
This case revealed that complete lymph flow reconstruction was possible by transferring a true perforator LN flap and ELLA using an intact recipient lymphatic vessel from a nonaffected region, which was confirmed with postoperative ICG lymphography. Unlike conventional LNT methods that can decongest lymph only through an LN's drainage vein, our method allows physiological lymph flow reconstruction through both an LN's ELV and a drainage vein.23, 24 Since lymph drained into an LN flows out
Disclaimers and disclosure
None.
Ethics
This case was reported under the University of Tokyo Hospital ethics committee- and Tokyo Metropolitan Bokutoh Hospital ethics committee-approved protocol.
Funding
None.
Conflict of interest
None declared.
Acknowledgments
The author (T.Y.) thanks Rico for support in preparation of the manuscript.
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Prior presentations: This article was presented in 1) part at the 3rd International Symposium on Lymphedema Surgical Treatment, Barcelona, Spain, March 5, 2014, and 2) at the 25th International Society of Lymphology Congress, San Francisco, USA, September 10, 2015.