Page 26 - Read Online

Onishi et al. Plast Aesthet Res 2024;11:5 https://dx.doi.org/10.20517/2347-9264.2023.102 Page 7 of 10

Figure 5. A patient in the early group before (A) and after (B) LVA. PEV for the affected limb reduced from 16.6 to 6.4 after LVA
surgery. LVA: lymphaticovenous anastomosis; PEV: percent excess volume.

Figure 6. A patient in the non-early group before (A) and after (B) LVA. PEV of the affected limb decreased from 50.7 to 37.5 after
LVA, showing a constant decrease, but still not less edema. LVA: lymphaticovenous anastomosis; PEV: percent excess volume.

significantly better outcomes in PEV and volume reduction rate 1 year after LVA, adjusting for patient
background as much as possible using the propensity score with an overlap weighting method. These results
suggest the benefit of early indication of LVA after the initiation of CDT in patients with upper extremity
lymphedema. This supports previous literature , which argues that delaying reconstructive surgery beyond
[4]
1 year may compromise its efficacy because of irreversible damage to the lymphatic system. This is the first
study to show how early LVA should be indicated for a better treatment prognosis of upper extremity
lymphedema.

[8]
CDT is considered more beneficial when it begins as an early intervention . The mechanisms behind
successful CDT are the remaining lymphatic drainage routes in the affected extremity and stimulation of
smooth muscle contraction of lymphatic vessels, which is a major premise for the existence of functional
lymphatic vessels . Namely, the efficacy of CDT depends on the residual lymphatic route. However,
[9]
residual lymphatic pathways exhibit alterations in drainage patterns as early as stage 0/I , which indicates
[10]
most patients who are starting CDT already have a functional loss to some extent, potentially affecting the
efficacy of CDT. Since microsurgical treatment such as LVA increases lymphatic return and relieves
[1]
[4]
lymphatic hypertension , it should work complementarily as an adjunct to CDT to improve treatment
efficiency and outcomes.