PMC5724635_01
(a) Preoperative appearance of Case 1. Obvious edema can be observed in the bilateral legs. (b) Clinical appearance of Case 1, 7 months after lymphatic venous anastomosis. The condition of the lymphedema is improved. (c) Lymphoscintigraphic finding in Case 1. Radioisotope was injected in the bilateral dorsum of the foot. Many dilated lymphatic vessels and dermal backflow are observed in the bilateral legs.
10.1177_2050313X17745207-fig1.jpg
PMC5724635_01_10.1177_2050313X17745207-fig1.jpg
fig1-2050313X17745207
When she consulted our hospital, she had bilateral lower limb edema with a severe deformity (Figure 1(a)). On lymphoscintigraphy, we observed many dilated collateral lymphatic vessels and dermal backflow in the bilateral lower extremities (Figure 1(c)), which was classified as type 3 in accordance with Maegawa's classification. After the operation, her lymphedema was alleviated, and she could start wearing elastic stocking every day (Figure 1(b)).
The preoperative echographic finding and intraoperative finding in the lymphaticovenous anastomosis (LVA) in Case 1. Blue arrow: subcutaneous vein; yellow arrow: collecting lymphatic vessel; and white arrow: superficial fascia. (a) Preoperative echographic finding in the right thigh. A circular structure which was thought to be the lymphatic vessel is observed beneath the superficial fascia. (b) Intraoperative finding in the right thigh. The subcutaneous vein and collecting lymphatic vessel can be observed just as on echography and we could anastomose them. The square in the green background indicates 1 mm.
10.1177_2050313X17745207-fig2.jpg
PMC5724635_01_10.1177_2050313X17745207-fig2.jpg
fig2-2050313X17745207
Tokyo, Japan) and could observe circular structures beneath the superficial fascia (Figure 2(a)). They were not colored on color Doppler. We performed four LVAs for the right leg and two LVAs for the left leg in accordance with the findings from preoperative examinations (Figure 2(b)) and resection of genital acquired lymphangiectasia under local anesthesia.
PMC5724635_02
(a) Preoperative appearance of Case 2. Edema can be observed in the left leg. (b) Lymphoscintigraphic finding of Case 2. Radioisotope was injected in the bilateral dorsum of the foot. Linear lymphatic vessels and inguinal lymph nodes can be observed in the right leg. The left lower leg and thigh shows dermal backflow. The number of inguinal lymph nodes is limited.
10.1177_2050313X17745207-fig3.jpg
PMC5724635_02_10.1177_2050313X17745207-fig3.jpg
fig3-2050313X17745207
After she consulted our hospital, we performed lymphoscintigraphy and made a diagnosis of lymphedema (type 1 for the right leg and type 3 for the left leg; Figure 3).
Preoperative echographic finding and intraoperative findings in lymphaticovenous anastomosis (LVA) in Case 2. Blue arrow: subcutaneous vein; yellow arrow: collecting lymphatic vessel; and white arrow: superficial fascia. (a) Preoperative echographic finding in the left proximal thigh in Case 2. A circular structure can be observed beneath the superficial fascia and seems to be the lymphatic vessel. (b) Preoperative echographic finding in the left distal thigh in Case 2. (c) Intraoperative finding in the left proximal thigh. The subcutaneous vein and collecting lymphatic vessel can be observed just as on echography and we could anastomose them. The square in the green background indicates 1 mm. Lymphatic fluid flowing into the vein is shown. (d) Intraoperative finding in the left distal thigh. The square in the green background indicates 1 mm. Lymphatic fluid flows into the vein.
10.1177_2050313X17745207-fig4.jpg
PMC5724635_02_10.1177_2050313X17745207-fig4.jpg
fig4-2050313X17745207
ICG lymphography preoperatively. In echography, we found vascular architectures beneath the superficial fascia, which we marked as lymphatic vessels (Figure 4(a) and (b)). We performed LVA based on the findings of preoperative examinations and found the dilated lymphatic vessels just as observed on echography (four LVAs for the left leg and one LVA for the right leg; Figure 4(c) and (d)).