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Seki et al. Plast Aesthet Res 2021;8:58 https://dx.doi.org/10.20517/2347-9264.2021.80 Page 7 of 11

Table 1. Characteristics of patients in the conventional LVA group and dynamic LVA group [20]
Conventional LVA (n = 15) Dynamic LVA (n = 15) P value
Age (years) 37-69 (mean, 53.3) 48-74 (mean, 59.1) 0.076 †
Sex
‡
Female 15 (100%) 15 (100%) 1.000
Male 0 (0%) 0 (0%)
†
Duration of edema (months) 3-53 (mean, 19.1) 3-124 (mean, 36.9) 0.128
BMI 17.4-31.8 (mean, 22.7) 16.5-31.1 (mean, 23.2) 0.750 †
‡
Etiology of lymphedema 1.000
Breast cancer treatment 15 (100%) 15 (100%)
ISL stage
2a 9 (60.0%) 9 (60.0%) 1.000 ‡
2b 6 (40.0%) 6 (40.0%)
2
‡
†
Number and percentage of patients are shown unless otherwise indicated. By Mann-Whitney U test; by χ test. LVA: Lymphaticovenular
[20]
anastomosis; BMI: body mass index; ISL: International Society of Lymphology. The original source of Table 1 is from Ref. with permission for
reuse.
Table 2. Postoperative improvement in the conventional LVA group and dynamic LVA group [20]
Conventional LVA Dynamic LVA P value
1 month after surgery (n = 15 limbs) (n = 15 limbs)
†
Limb volume reduction 13/15 (86.7%) 15/15 (100%) 0.0877
Change in UEL index 3.74 ± 5.82 8.12 ± 3.08 0.0176 ‡
(-7.68-12.18) (3.22-14.52)
6 months after surgery (n = 15 limbs) (n = 15 limbs)
Limb volume reduction 11/15 (73.3%) 15/15 (100%) 0.0130 †
‡
Change in UEL index 2.62 ± 10.39 8.74 ± 3.58 0.0458
(-29.33-10.97) (4.41-18.52)
1 year after surgery (n = 13 limbs) (n = 15 limbs)
Limb volume reduction 9/13 (69.2%) 15/15 (100%) 0.0085 †
‡
Change in UEL index 2.03 ± 9.36 10.23 ± 6.16 0.0140
(-15.51-16.53) (3.83-26.17)
† 2 ‡
Number and percentage of patients are shown unless otherwise indicated. By χ test; by Mann-Whitney U test. LVA: Lymphaticovenular
anastomosis; UEL: upper extremity lymphedema. The original source of Table 2 is from Ref. [20] with permission for reuse.

more frequently in the superior-edge-of-the-knee incision group than in the non-superior-edge-of-the-knee
incision group (60.0% vs. 18.8%, P = 0.002). The postoperative volume reduction in LEL index at one year
was significantly greater in the superior-edge-of-the-knee incision group than in the non-superior-edge-of-
the-knee incision group (24.427 ± 12.400 vs. 0.032 ± 20.535; P < 0.001) [Figure 5].

Another study of the superior-edge-of-the-knee incision method, a case series study of 10 early ISL stage 2
LEL patients, was performed . All 10 patients were treated by only a single LVA using the superior-edge-
[22]
of-the-knee incision method. The mean follow-up time was 7.70 ± 3.30 months, and the volume changes in
LEL index was significantly reduced in all 10 patients postoperatively (postoperative LEL index 222.532 ±
19.390 vs. preoperative LEL index 242.692 ± 19.026; P = 0.031).

CONCLUSIONS
The functional LVA utilizing muscle pumping in daily movements as an alternative power source to propel
lymphatic fluid at the point of LVA is beneficial for treating upper and lower extremity lymphedema.