Page 100 - Read Online

Page 2 of 9 Onishi et al. Plast Aesthet Res 2021;8:50 https://dx.doi.org/10.20517/2347-9264.2021.75

Conclusion: It would be highly beneficial to combine reduction treatment in the early postoperative period after
LVA surgery to maximize treatment outcomes.

Keywords: Lymphedema, complex decongestive therapy, lymphaticovenular anastomosis, reduction treatment,
compression, exercise

INTRODUCTION
The mainstay of lymphedema treatment is complex decongestive therapy (CDT). CDT is a conservative
treatment method that includes compression therapy, manual lymph drainage, remedial exercise, and skin
care, and it has been proven to be effective in reducing edema . However, studies have shown that the
[1-4]
[5,6]
effectiveness of CDT is dependent on residual lymphatic function . Furthermore, CDT does not address
functional insufficiency in the lymphatic drainage system . In contrast, microsurgical treatments, including
[7]
lymphaticovenular anastomosis (LVA) and vascularized lymph node transfer, increase lymph drainage
routes and boost lymphatic drainage, which all play an essential role in improving intrinsic lymphatic
function .
[7]

[7-9]
Studies have indicated the importance of compression therapy after LVA ; however, no general consensus
[10]
has been reached regarding when to start and what to combine in the early postoperative period . In
general, CDT consists of two phases: a reduction phase, followed by a maintenance phase [1-3,11] . Most
patients are likely to undergo LVA surgery during their maintenance phase [12,13] . According to the literature,
after LVA surgery, patients typically resume and continue maintenance treatment, including compression
therapy, after 1-4 weeks of postoperative interruption [7,9,10] . However, to our knowledge, no study has
reported an integration of conservative therapy in the early postoperative period, especially within 1 week
after LVA.

In the early postoperative period, we hypothesized that reduction treatment could be performed more
efficiently with a boosted lymphatic drainage through the LVA. Based on this hypothesis, we adopted
reduction treatment in the early postoperative period after LVA surgery in October 2015. This study aimed
to clarify the efficacy of the integration of LVA and perioperative reduction treatment (PORT), in the search
for an optimal combination of surgery and conservative therapy for lymphedema, by retrospectively
reviewing our experience treating patients with lower extremity lymphedema.

METHODS
We conducted a retrospective chart review of 134 consecutive patients with lower extremity lymphedema
who were treated with LVA, by the same surgeon (FO), at two affiliated hospitals, Saitama Medical Center
and Tochigi Cancer Center, between 2014 and 2018. The exclusion criteria were as follows: follow-up period
of less than 1 year and patients who did not undergo appropriate compression therapy before and after LVA
surgery. Patients with insufficient response to CDT or those whose clinical improvement plateaued
following CDT were indicated for LVA surgery. PORT, which included compression therapy and remedial
exercise, has been adopted in our clinical practice since October 2015 for use during the early postoperative
period immediately following LVA. Prior to this, no additional perioperative intervention had been
provided for patients who underwent LVA. In both cases, all patients who underwent LVA surgery wore
elastic stockings as baseline maintenance therapy preoperatively for some duration (more than 1 year on
average) and resumed wearing the stockings 1 week postoperatively. This study’s cohort was divided into
two patient groups: patients who underwent PORT following LVA surgery (PORT group) and patients who
underwent no additional perioperative intervention after LVA surgery during the early postoperative period