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Pandey et al. Plast Aesthet Res 2021;8:47 Plastic and
DOI: 10.20517/2347-9264.2021.61
Aesthetic Research

Perspective Open Access

Supermicrosurgical lymphaticovenular anastomosis
vs. vascularized lymph vessel transplant - technical

optimization and when to perform which

Sonia Kukreja Pandey, Vahe Fahradyan, Lynn M. Orfahli, Wei F. Chen
Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Correspondence to: Prof. Wei F. Chen, Professor of Plastic Surgery, Head, Regional Microsurgery & Supermicrosurgery, Co-
Director, Center for Lymphedema Research and Reconstruction, Department of Plastic and Reconstructive Surgery, Cleveland
Clinic Foundation, 9500 Euclid Avenue, Desk A60, Cleveland, OH 44195, USA. E-mail: weifchen@hotmail.com

How to cite this article: Pandey SK, Fahradyan V, Orfahli LM, Chen WF. Supermicrosurgical lymphaticovenular anastomosis vs.
vascularized lymph vessel transplant - technical optimization and when to perform which. Plast Aesthet Res 2021;8:47.
https://dx.doi.org/10.20517/2347-9264.2021.61

Received: 9 Jun 2021 First Decision: 5 Jul 2021 Revised: 12 Jul 2021 Accepted: 23 Jul 2021 First online: 3 Aug 2021
Academic Editor: Matthew L Iorio Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Early surgical intervention for lymphedema can delay, prevent, and even reverse lymphatic degeneration.
Vascularized lymph vessel transplant (VLVT) has emerged as an alternative to vascularized lymph node transplant
(VLNT) for the treatment of advanced, fluid-predominant lymphedema, providing highly favorable outcomes with
reduced donor-site complications. Lymphaticovenular anastomosis (LVA) has traditionally been reserved for early
disease. However, technical refinements have improved its results and expanded its efficacy, creating an overlap
between the indications for VLVT/VLNT and LVA. This article describes our technical approach to VLVT and LVA
and explores the nuances of treatment selection in the light of their shifting indications.

Keywords: Lymphedema, supermicrosurgery, lymphaticovenular anastomosis, lymphovenous bypass, vascularized
lymph vessel transplant, vascularized lymph node transplant

INTRODUCTION
Supermicrosurgical advancements over the past few decades have given rise to a myriad of efficacious
options for surgical treatment of lymphedema. In contrast to traditional belief, recent evidence shows that

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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