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Chen et al. Plast Aesthet Res 2021;8:36 https://dx.doi.org/10.20517/2347-9264.2021.33 Page 5 of 6

Table 2. The characteristics between local and general anesthesia patients with lymphedemanular anastomosis
N = 29 Anesthesia methods P value
Local (n = 21) General (n = 8)
Sex (F/M) 18:3 7:1 0.472
Age (years) 63.0 57.63 0.363
ASA score 3.45 3.75 0.682
BMI 27.89 26.63 0.361
OP times (hours) 3.67 5.19 0.048
Cancer (yes/no) 17:4 5:3 0.045
Risk factors (0-3) 0.85 0.66 0.052
Reduction rate-immediate 2.025% 4.353% 0.045
Reduction rate-late 4.330% 5.707% 0.052
Follow-up (months) 8.4 10 -
LVA number (n) 7.095 6.75 0.102
Complications 0 0 -
BMI: Body mass index; Risk factors: BMI > 28, age > 65, autoimmune disease; LVA: lymphaticovenular anastomosis; ASA: American Society of
Anesthesiologists.

neural deficit, pneumonia, urinary tract infection, systemic sepsis, or septic shock, can be severe and are
ideally avoided. Therefore, instead of general anesthesia, local anesthesia could be the resolution for LVA in
patients with high ASA PS score to reduce the surgical morbidities. Therefore, general anesthesia should be
preserved for vascularized lymphatic vessel transfer or lipectomy in the patient at high ASA PS score. In
2020, Yoshida et al. described local anesthesia is a practical choice of anesthesia in Fowler’s Position
[11]
because of the lower invasiveness of LVA. In our study, we have 21 patient who receive ongoing oncological
therapies. Among this study, local anesthesia does not decrease the numbers of lymphaticovenular
anastomosis and neither compromises the reduction of limb circumferences at 3 months follow-up. Besides,
there were no complications in our study. With LVA under local anesthesia, safety and effectiveness can
both be achieved in advanced cancer patients with high ASA PS score (> 3).

DECLARATIONS
Acknowledgments
Thanks to Professor Koshima Isao for leading me into the field of supermicrosurgery. I appreciated his
kindness in my fellowship from April to October in 2020 at Hiroshima University Hospital of Japan.

Authors’ contributions
Completed all surgeries of these patients and wrote the article: Chen CC
Helped in the data collection and patient care: Chen CC
Helped to improve the article: Yang SF
Helped in data analysis of the article: Chang CC

Availability of data and materials
Data will be deposited into data repositories or published as supplementary information in the journal.

Financial support and sponsorship
None.