Microsurgery: Lymphaticovenular Anastomosis for the Treatment of Lymphedema

Recent advancements in microsurgery and supermicrosurgery have made lymphedema a surgically manageable condition. Lymphaticovenular anastomosis (LVA) is an established supermicrosurgical treatment of lymphedema. LVA is minimally invasive and conceptually simple: lymphatic vessels are anastomosed directly into superficial veins, allowing lymphatic outflow to drain into veins and thus bypass obstructed lymphatic drainage pathways. However, LVA is not widely practiced due to perceived technical complexity, lack of technique standardization, and some reports of inconsistent outcomes. However, many surgical groups, including ours, have reported reliably favorable outcomes with LVA. We believe the inconsistency in some reported outcomes is likely related to variability in patient selection, surgical plan and technique, and postoperative care. In this chapter, the senior author (WFC) shares his experience with LVA, reviewing patient selection, surgical planning, surgical technique, advanced technical pearls, and postoperative care. After reading this chapter, the readers should have sufficient clinical and technical knowledge to begin performing LVA and achieving favorable outcomes.