Page 66 - Read Online

Seki et al. Plast Aesthet Res 2021;8:44 https://dx.doi.org/10.20517/2347-9264.2021.74 Page 9 of 11

Figure 5. Making a comfortable wound bed for LVA. After the fixations of the incision are all released, both sides of the incision are
carefully pulled upward to confirm whether there are any fibers or other lymphatic vessels disturbing the lymph-to-venous flow at the
anastomosis. These fibers and/or vessels (right) should be resected to promote lymphatic flow at the LVA to keep the longtime
patency with lymphedema improvements.

DECLARATIONS
Acknowledgments
The authors thanks Isao Koshima for sharing his knowledge, surgical techniques, passion, and zeal for
lymphedema treatment. This article is reported by all our respect to the father of supermicrosurgery, Isao
Koshima. And the senior author thanks Yoshiharu, Miyuki, Hanano, Mayoko, and all members of our
department for their kind support during preparation of this manuscript. At last, the senior author thanks
Takumi Yamamoto for sharing his special technique and knowledge on supermicrosurgical LVA.

Authors’ contributions
Preparation of the article: Seki Y
Teaching importance of developing new ideas and innovations continuously to the senior author:
Kajikawa A
Respect the concept of Isao Koshima’s supermicrosugery: Seki Y, Kajikawa A

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
Both authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
This study is obtained ethical approval (NO. 4767).