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Seki et al. Plast Aesthet Res 2021;8:58 Plastic and
DOI: 10.20517/2347-9264.2021.80
Aesthetic Research

Review Open Access

Functional lymphaticovenular anastomosis for
peripheral lymphedema: incision selection methods

with muscle pumping

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Yukio Seki , Akiyoshi Kajikawa , Rintaro Asai , Meri Takada , Takumi Yamamoto , Takahiro Terashima ,
Norimitsu Kurogi 2
1
Department of Plastic and Reconstructive Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa 216-8511,
Japan.
2
Department of General Surgery, Shonan Atsugi Hospital, Atugi, Kanagawa 243-8551, Japan.
Correspondence to: Dr. Yukio Seki, Department of Plastic and Reconstructive Surgery, St. Marianna University School of
Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan. E-mail: yukioseki.pla@gmail.com
How to cite this article: Seki Y, Kajikawa A, Asai R, Takada M, Yamamoto T, Terashima T, Kurogi N. Functional
lymphaticovenular anastomosis for peripheral lymphedema: incision selection methods with muscle pumping. Plast Aesthet Res
2021;8:58. https://dx.doi.org/10.20517/2347-9264.2021.80
Received: 7 Jul 2021 First Decision: 16 Aug 2021 Revised: 4 Sep 2021 Accepted: 18 Sep 2021 Published: 5 Nov 2021

Academic Editors: Matthew L. Iorio, Melissa B. Aldrich Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Lymphaticovenular anastomosis (LVA) is a highly effective, minimally invasive surgical treatment for lymphedema.
The clinical effect of LVA begins immediately after the creation of the lymph-to-venous pathway. However, the
long-term effect of LVA is not always promised when the lymph-to-venous bypass has any potential risk of
occlusion, especially when the disorder has reached the late stage. The reasons of postoperative LVA occlusion are
considered both a technical matter in performing LVA and a strategic matter in planning LVA. This article focuses
on the effective preoperative LVA planning methodology of “functional LVA” for peripheral lymphedema, in which
continuous and strong lymph flow at the anastomosis is created by the muscle pumping power of patients’ natural
motions at the selected incision point. The current functional LVAs which we have developed are the dynamic LVA
method for upper extremity lymphedema and the superior-edge-of-the-knee incision method for lower extremity
lymphedema. Because these methods reduce the risk of postoperative LVA occlusion by continuous lymph-to-
venous flow at the LVA, functional LVAs keep long-term clinical effect in reduction of lymphedema.

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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