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Liang et al. Plast Aesthet Res 2023;10:71 https://dx.doi.org/10.20517/2347-9264.2023.81 Page 7 of 13

Table 1. Patient demographic characteristics
Age (years) Average (range) 62.6 (47~80)
Sex Female 41
Male 0
2
BMI, Kg/m , median (IQR) Average (range) 24.2 (20~31)
Lymphedema duration (year) Average (range) 11.82 (5~25)
Axillary lymphadenectomy + 40
- 1
Adjuvant radiotherapy + 41
- 0
Adjuvant chemotherapy + 38
- 3
ISL classification 1 0
2a 5
2b 33
3 3
Follow-up (months) Average (range) 12.1 (5~24)
Preoperative ultrasound character of lymphatic vessel / Total LVA Shunts 133/212 62.7%
Preoperative ultrasound character of vein/ Total LVA shunts 196/212 92.4%

Figure 5. A: A patient with ISL grade 3 BCRL of the left upper limb. Preoperative findings included regional skin fibrosis and limited
elbow range of motion due to soft tissue swelling; B: Twelve months post-LVA, the skin texture softened and skin dyspigmentation
improved. C. Improved range of motion of the elbow.

preoperative figure to that at 1 month after surgery, each patient’s TC had a percentage decrease ranging
from 2.79%-20.35% (mean 9.80%). Similarly, comparing their TC values preoperatively to 3 months after
surgery showed a percentage decrease of 4.39%-28.30% (mean 11.80%). The differences in TC values were
statistically significant (P < 0.0001).

DISCUSSION
Supermicrosurgical LVA was first described by Koshima et al. in 1999, and its popularity has since
remained steadfast and not waned over the years . Treatment of lymphedema is undeniably complex and
[2]
requires various specialists to participate in a concerted multidisciplinary and multi-modal approach .
[28]
Newer physiologic procedures have been developed, such as free lymph node transfer that can be done
either in isolation or in combination with other procedures [29,30] . Nonetheless, LVA surgery has compelling
advantages, making it relevant over the years. It has minimal morbidity and downtime. It can be
conveniently done under local anesthesia or as a day procedure. The surgery can be repeated as necessary to