Topic: LVA treated uncompensated lymphedema induced by chronic inflammation on lower extremity

Abstract

Objective
Lower leg uncompensated lymphedema was the ultimate found when chronic inflammatory diseases like chronic severe venous insufficiency (C5~C6 stage), chronic psoriasis or skin-related autoimmune disorders. The common findings were lymphorrhea, warty hyperkeratosis, chronic stasis ulcer, recurrent cellulitis, or even lipodermatosclerosis(LDS). This study was aimed to outline the clinical effectiveness & efficacy of lymphovenous anastomosis (LVA) could ease sequential lymphedema to promote wound healing.

Material and Methods
LVA was performed on 33 lower extremities, 28 patients (3 cases of chronic skin disease; 30 cases were stage C5, C6 venous ulcers) who had recurrent cellulitis several times with lymphorrhea or developed severe ulcers that were refractory to skin
grafts, or conservative therapy.

Results
All patients received 1-3(M = 1.6) incisions of LVAs, and 1-5(M = 2.5) anastomosis shunts that were performed on each extremity. All chronic ulcers either combined with skin graft or not were healed within 6-12 weeks. 2(2/33 = 6.1 %) cases has recurrent ulceration during the 1st year follow up period (3-25 months, M= 12.1). Besides, lymphorrhea ceased, warty hyperkeratosis vanished, chronic stasis ulcer healed, and cellulitis frequency was decreased during the follow-up period.

Conclusions
LVAs are considered as adjunctive therapy to decrease the lymphorrhea and ease the local regional lymphedema on C5, C6 venous ulcer even combined with LDS cases. A promising way efficiently shortens wound healing and decrease health care burden.