Volume 41 Issue 6
Jun.  2025
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Yang Chen, Ma Gejia, Zhou Xuchuan, et al. Application efficacy of lymph pads in complete decongestive therapy after lymphatico-venous anastomosis combined with liposuction in patients with lower limb lymphedema[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2025, 41(6): 552-558. Doi: 10.3760/cma.j.cn501225-20241209-00481
Citation: Yang Chen, Ma Gejia, Zhou Xuchuan, et al. Application efficacy of lymph pads in complete decongestive therapy after lymphatico-venous anastomosis combined with liposuction in patients with lower limb lymphedema[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2025, 41(6): 552-558. Doi: 10.3760/cma.j.cn501225-20241209-00481

Application efficacy of lymph pads in complete decongestive therapy after lymphatico-venous anastomosis combined with liposuction in patients with lower limb lymphedema

doi: 10.3760/cma.j.cn501225-20241209-00481
Funds:

The Youth Talent Support Program of Xi'an Association for Science and Technology 959202413021

The Key Project of the Research Fund of Xi'an Central Hospital 2024ZD03

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  •   Objective  To evaluate the application efficacy of lymph pads in complete decongestive therapy after lymphatico-venous anastomosis (LVA) combined with liposuction in patients with lower limb lymphedema.  Methods  This study was a historical control study. From June 2021 to January 2023, a total of 23 patients who underwent LVA combined with liposuction and then complete decongestive therapy without application of lymph pads at the Department of Burn, Plastic and Cosmetic Surgery of Xi'an Central Hospital of Xi'an Jiaotong University (hereinafter referred to as our department) were included as control group. There were 2 males and 21 females in this group, with the age of 58±10 years. From February 2023 to January 2024, another 23 patients who underwent LVA combined with liposuction and then complete decongestive therapy with additional application of lymph pads at our department were included as lymph pad group. There were 3 males and 20 females in this group, with the age of 59±11 years. Before treatment and at 6 and 12 months of treatment, the circumferences of the dorsum of the foot, ankle joint, and upper edge of the knee joint of the affected limbs were measured, and the total score of lymphedema functioning, disability and health questionnaire for lower limb lymphedema (Lymph-ICF-LL) and score of lower limb function in Lymph-ICF-LL were recorded in patients in the two groups.  Results  At 6 and 12 months of treatment, the circumferences of the dorsum of the foot, ankle joint, and upper edge of the knee joint in patients in lymph pad group were (22.9±1.7), (26±3), (44±8) cm and (20.7±1.7), (25±3), (42±6) cm, respectively, which were significantly smaller than (24.3±2.3), (29±4), (49±10) cm and (23.9±2.2), (29±4), (48±12) cm in control group (with t values of 2.18, 2.29, 2.09, and 5.84, 3.92, 2.31, respectively, P < 0.05), and the mean differences (95% confidence intervals) between the two groups were 1.3 (0.1 to 2.5), 2 (0 to 4), 5 (0 to 10) cm and 3.3 (2.2 to 4.5), 4 (2 to 6), 6 (1 to 12) cm, respectively. There were no statistically significant differences in the total Lymph-ICF-LL scores of the affected limbs between the two groups of patients before treatment and at 6 and 12 months of treatment (P > 0.05). At 6 and 12 months of treatment, the lower limb function scores in Lymph-ICF-LL of the affected limbs in lymph pad group of patients were significantly lower than those in control group (with t values of 2.24 and 2.44, respectively, P < 0.05), and the mean differences (95% confidence intervals) between the two groups were 5 (1 to 9) and 5 (1 to 9) cm, respectively.  Conclusions  During complete decongestive therapy following LVA combined with liposuction, the application of lymph pads can significantly reduce the circumference of the dorsum of the foot, ankle joint, and knee joint in patients with lower limb lymphedema, and also improve their lower limb function.

     

  • A systematic evaluation was conducted on the clinical effects of lymph pad in complete decongestive therapy after lymphatico-venous anastomosis combined with liposuction in patients with lower limb lymphedema, and it was confirmed that the lymph pad therapy could significantly reduce the circumferences of the dorsum of the foot, ankle joint, and knee joint, and improve the function of lower limbs in patients.
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  • [1]
    Hock LA, Nürnberger T, Koban KC, et al. Quality of life in lymphedema patients treated by microsurgical lymphatic vessel transplantation-a long-term follow-up[J]. Life (Basel), 2024, 14(8): 957. DOI: 10.3390/life14080957.
    [2]
    Akita S, Yoshida K, Omura M, et al. Noninvasive, objective evaluation of lower extremity lymphedema severity using shear wave elastography: a preliminary study[J]. J Plast Reconstr Aesthet Surg, 2021, 74(12): 3377-3385. DOI: 10.1016/j.bjps.2021.05.013.
    [3]
    Tedeschi R. Biomechanical alterations in lower limb lymphedema: implications for walking ability and rehabilitation[J]. Phlebology, 2023, 38(8): 496-502. DOI: 10.1177/02683555231188236.
    [4]
    Dessources K, Aviki E, Leitao MM Jr. Lower extremity lymphedema in patients with gynecologic malignancies[J]. Int J Gynecol Cancer, 2020, 30(2): 252-260. DOI: 10.1136/ijgc-2019-001032.
    [5]
    Letellier ME, Ibrahim M, Towers A, et al. Incidence of lymphedema related to various cancers[J]. Med Oncol, 2024, 41(10): 245. DOI: 10.1007/s12032-024-02441-2.
    [6]
    Wong M, Eaton PK, Zanichelli C, et al. The prevalence of undiagnosed postoperative lower limb lymphedema among gynecological oncology patients[J]. Eur J Surg Oncol, 2022, 48(5): 1167-1172. DOI: 10.1016/j.ejso.2021.12.464.
    [7]
    Şahinoğlu E, Ergin G, Karadibak D. The efficacy of change in limb volume on functional mobility, health-related quality of life, social appearance anxiety, and depression in patients with lower extremity lymphedema[J]. Phlebology, 2022, 37(3): 200-205. DOI: 10.1177/02683555211061011.
    [8]
    Bobrek K, Nabavizadeh R, Nabavizadeh B, et al. How to care and minimize the sequelae of lower extremity lymphedema [J]. Semin Oncol Nurs, 2022, 38(3): 151270. DOI: 10.1016/j.soncn.2022.151270.
    [9]
    Son JH, Min JH, Kim IH, et al. The clinical usefulness of ultrasonographic measurement technique in patients with lower extremity lymphedema[J]. Lymphat Res Biol, 2023, 21(1): 20-27. DOI: 10.1089/lrb.2021.0089.
    [10]
    Nuwayhid R, Langer S, von Dercks N. Cost comparison of conservative vs. surgical treatment of chronic lymphedema [J]. Chirurgie (Heidelb), 2025, 96(1): 41-47. DOI: 10.1007/s00104-024-02123-9.
    [11]
    Yoshida S, Koshima I, Imai H, et al. Effect of postoperative compression therapy on the success of liposuction in patients with advanced lower limb lymphedema[J]. J Clin Med, 2021, 10(21): 4852. DOI: 10.3390/jcm10214852.
    [12]
    Karlsson T, Hoffner M, Ohlin K, et al. Complete reduction of leg lymphedema after liposuction: a 5-year prospective study in 67 patients without recurrence[J]. Plast Reconstr Surg Glob Open, 2023, 11(12): e5429. DOI: 10.1097/GOX.0000000000005429.
    [13]
    Torgbenu E, Luckett T, Buhagiar MA, et al. Guidelines relevant to diagnosis, assessment, and management of lymphedema: a systematic review[J]. Adv Wound Care (New Rochelle), 2023, 12(1): 15-27. DOI: 10.1089/wound.2021.0149.
    [14]
    Executive Committee of the International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 Consensus Document of the International Society of Lymphology[J]. Lymphology, 2020, 53(1): 3-19.
    [15]
    Devoogdt N, De Groef A, Hendrickx A, et al. Lymphoedema functioning, disability and health questionnaire for lower limb lymphoedema (Lymph-ICF-LL): reliability and validity [J]. Phys Ther, 2014, 94(5): 705-721. DOI: 10.2522/ptj.20130285.
    [16]
    Lu C, Li GL, Deng DH, et al. Transcutaneous electrical acupoint stimulation combined with warm acupuncture for breast cancer related upper limb lymphedema: a retrospective cohort study[J]. Chin J Integr Med, 2023, 29(6): 534-539. DOI: 10.1007/s11655-022-3684-7.
    [17]
    Karlsson T, Karlsson M, Ohlin K, et al. Liposuction of breast cancer-related arm lymphedema reduces fat and muscle hypertrophy[J]. Lymphat Res Biol, 2022, 20(1): 53-63. DOI: 10.1089/lrb.2020.0120.
    [18]
    Onoda S, Satake T, Hamada E. Super-microsurgery technique for lymphaticovenular anastomosis[J]. J Vasc Surg Venous Lymphat Disord, 2023, 11(1): 177-181. DOI: 10.1016/j.jvsv.2022.08.008.
    [19]
    Cheng MH, Tee R, Chen C, et al. Simultaneous ipsilateral vascularized lymph node transplantation and contralateral lymphovenous anastomosis in bilateral extremity lymphedema with different severities[J]. Ann Surg Oncol, 2020, 27(13): 5267-5276. DOI: 10.1245/s10434-020-08720-2.
    [20]
    陈佳佳, 高敏哲, 汪立, 等. 妇科相关肿瘤术后下肢淋巴水肿合并会阴部水肿的综合治疗初探[J]. 组织工程与重建外科杂志, 2022, 18(3): 242-246. DOI: 10.3969/j.issn.1673-0364.2022.03.008.
    [21]
    Dionyssiou D, Sarafis A, Tsimponis A, et al. Long-term outcomes of lymph node transfer in secondary lymphedema and its correlation with flap characteristics[J]. Cancers (Basel), 2021, 13(24): 6198. DOI: 10.3390/cancers13246198.
    [22]
    Shimbo K, Kawamoto H, Koshima I. Conservative treatment versus lymphaticovenular anastomosis for early-stage lower extremity lymphedema[J]. J Vasc Surg Venous Lymphat Disord, 2023, 11(6): 1231-1240. DOI: 10.1016/j.jvsv.2023.06.013.
    [23]
    Mihara M, Hara H, Furniss D, et al. Lymphaticovenular anastomosis to prevent cellulitis associated with lymphoedema[J]. Br J Surg, 2014, 101(11): 1391-1396. DOI: 10.1002/bjs.9588.
    [24]
    Caretto AA, Stefanizzi G, Garganese G, et al. Treatment of early-stage gynecological cancer-related lower limb lymphedema by lymphaticovenular anastomosis-the triple incision approach[J]. Medicina (Kaunas), 2022, 58(5): 631. DOI: 10.3390/medicina58050631.
    [25]
    刘长瑞, 王鹤君, 王营营, 等. 超显微外科淋巴管静脉吻合术在肢体淋巴水肿中的应用[J]. 组织工程与重建外科杂志, 2025, 21(1): 77-82. DOI: 10.3969/j.issn.1673-0364.2025.01.014.
    [26]
    Karlsson T, Hoffner M, Brorson H. Liposuction and controlled compression therapy reduce the erysipelas incidence in primary and secondary lymphedema[J]. Plast Reconstr Surg Glob Open, 2022, 10(5): e4314. DOI: 10.1097/GOX.0000000000004314.
    [27]
    Hoffner M, Peterson P, Månsson S, et al. Lymphedema leads to fat deposition in muscle and decreased muscle/water volume after liposuction: a magnetic resonance imaging study[J]. Lymphat Res Biol, 2018, 16(2): 174-181. DOI: 10.1089/lrb.2017.0042.
    [28]
    郝昆, 孙宇光, 王仁贵, 等. 抽吸减容术治疗乳腺癌术后上肢淋巴水肿[J]. 组织工程与重建外科杂志, 2024, 20(1): 69-74, 82. DOI: 10.3969/j.issn.1673-0364.2024.01.005.
    [29]
    Brazio PS, Nguyen DH. Combined liposuction and physiologic treatment achieves durable limb volume normalization in class Ⅱ-Ⅲ lymphedema: a treatment algorithm to optimize outcomes[J]. Ann Plast Surg, 2021, 86(5S Suppl 3): S384-389. DOI: 10.1097/SAP.0000000000002695.
    [30]
    Gabriele G, Nigri A, Chisci G, et al. Combination of supramicrosurgical lymphatico-venular anastomosis (sLVA) and lymph-sparing liposuction in treating cancer-related lymphedema: rationale for a regional one-stage approach[J]. J Clin Med, 2024, 13(10): 2872. DOI: 10.3390/jcm13102872.
    [31]
    Zhou X, Ma G, Qi X, et al. Application of complete decongestive therapy after lymphaticovenular anastomosis of the lower limb combined with liposuction-a retrospective study research[J]. Phlebology, 2024, 39(1): 49-57. DOI: 10.1177/02683555231209056.
    [32]
    Brémond-Gignac D, Copin H, Kohler C, et al. The lateral inframalleolar fat pad: a poorly recognized anatomical structure[J]. Surg Radiol Anat, 2001, 23(5): 325-329. DOI: 10.1007/s00276-001-0325-2.
    [33]
    Yao B, Samuel LT, Acuña AJ, et al. Infrapatellar fat pad resection or preservation during total knee arthroplasty: a systematic review[J]. J Knee Surg, 2021, 34(4): 415-421. DOI: 10.1055/s-0039-1696692.
    [34]
    Arai KY, Sugimoto M, Ito K, et al. Repeated folding stress-induced morphological changes in the dermal equivalent[J]. Skin Res Technol, 2014, 20(4): 399-408. DOI: 10.1111/srt.12131.
    [35]
    Lee SO, Kim IK. Molecular pathophysiology of secondary lymphedema[J]. Front Cell Dev Biol, 2024, 12: 1363811. DOI: 10.3389/fcell.2024.1363811.
    [36]
    Ren Y, Kebede MA, Ogunleye AA, et al. Burden of lymphedema in long-term breast cancer survivors by race and age[J]. Cancer, 2022, 128(23): 4119-4128. DOI: 10.1002/cncr.34489.
    [37]
    Partsch H, Mosti G. Thigh compression[J]. Phlebology, 2008, 23(6): 252-258. DOI: 10.1258/phleb.2008.008053.
    [38]
    O'Brien JG, Chennubhotla SA, Chennubhotla RV. Treatment of edema[J]. Am Fam Physician, 2005, 71(11): 2111-2117.
    [39]
    Devitt M, Ramanan D, Armitstead J, et al. Usability evaluation of a novel compact pneumatic compression device for the treatment of lymphoedema: pilot study[J]. Phlebology, 2022, 37(8): 564-571. DOI: 10.1177/02683555221096298.
    [40]
    Soran A, Toktas O, Grassi A, et al. Adding pneumatic compression therapy in lower extremity lymphedema increases compliance of treatment, while decreasing the infection rate[J]. Lymphat Res Biol, 2022, 20(3): 315-318. DOI: 10.1089/lrb.2020.0086.
    [41]
    Hobday A. Use of compression therapy in patients with lymphoedema[J]. Nurs Stand, 2016, 30(27): 50-58; quiz 60. DOI: 10.7748/ns.30.27.50.s46.
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