Introduction
Lymphedema is a chronic, debilitating condition caused by an affected lymphatic system. Lymphaticovenous anastomosis (LVA), by which one or more patent lymphatic collecting vessels are connected to subcutaneous veins, shows promising results. LVA has gained popularity because of its minimal invasiveness, better aesthetic outcome, and lower treatment costs. Postoperative efficiency of these anastomosis can be evaluated in many ways. In this study, we evaluated the clinical effectiveness of LVA using ultrasound findings (skin and subcutaneous tissue thickness) by comparing the pre-operate status and the post-operate status (post-op a month, 3 months, 6 months, and 1 year).
Case 1
A 47-year-old patient with history of hysterectomy in 2008 presented swelling in right lower limb starting 2018. The patient’s condition did not improve after a year of conservative treatment, such as manual lymphatic drainage and elastic stocking compression. She underwent a surgical procedure performing lymphovenous anastomosis in three sites: one in right ankle and other in thigh.
Case 2
A 57-year-old patient presented swelling in left upper limb after breast conserving surgery due to left breast cancer in 2018. The conservative treatments on left upper limb did not ameliorate the symptom. She underwent a surgical procedure performing lymphovenous anastomosis in two sites of left forearm.
Method
After the initial preoperative evaluation, we had four postoperative follow up evaluations on skin and subcutaneous tissue thickness using ultrasound: a month, 3 months, 6 months, and a year after the LVA surgery. The patient’s skin and subcutaneous tissue thickness were assessed at 4 points using ultrasound probe : above 10cm and below 10cm of elbow or knee level.
Results
Skin and subcutaneous tissue thickness showed gradually decreasing tendency in both upper and lower limbs in a year after the LVA surgery. (Table 1, Table 2, Figure 1)
Conclusion
In this cases, LVA surgery showed meaningful decreasing trend in skin and subcutaneous tissue thickness a year after LVA surgery. Further research with a larger study population is to determine whether the ultrasound findings, such as skin and subcutaneous tissue thickness, are correlated to various independent variables affecting LVA surgery. |
