The Superior-Edge-of-the-Knee Incision Method in Lymphaticovenular Anastomosis for Lower Extremity Lymphedema.

BACKGROUND: Lymphatic vessel diameter and lymph flow are important for accurate anastomosis and effective lymph-to-venous flow in lymphaticovenular anastomosis. The authors developed a reliable method, the superioredge-of-the-knee incision method, for detecting and making the best use of high-flow lymphatic vessels in the distal medial thigh between the deep and superficial fascia, where movement of the knee, combined with compression between these fascial layers, theoretically results in upward propulsion of lymphatic fluid. METHODS: Intraoperative detection of large lymphatic vessels and of venous reflux and postoperative lymphedematous volume reduction were compared between 15 patients in whom lymphaticovenular anastomoses with the superior-edge-of-the-knee incision method were undergone and 15 in whom conventional lymphaticovenular anastomoses were undergone. RESULTS: Lymphaticovenular anastomosis at the thigh yielded 30 anastomoses in the superior-edge-of-the-knee incision group and 32 anastomoses in the non-superior-edge-of-the-knee incision group. Large lymphatic vessels were more frequently found in the superior-edge-of-the-knee incision group than in the non-superior-edge-of-the-knee incision group (60.0 percent versus 18.8 percent; p = 0.002). Venous reflux occurred less frequently in the superior-edge-of-the-knee incision group than in the non-superior-edge-of-the-knee incision group (10.0 percent versus 65.6 percent; p < 0.001). Reduction of the lower extremity lymphedema index was significantly greater in the superior-edge-of-the-knee incision group than in the non-superior-edge-of-the-knee incision group (24.427 ± 12.400 versus 0.032 ± 20.535; p < 0.001). CONCLUSION: The superior-edge-of-the-knee incision method facilitates detection and use of large, high-flow lymphatic vessels in the distal medial thigh, both of which are important for optimum therapeutic effects in patients with lower extremity lymphedema. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.