Popliteal lymphatico-venous anastomosis for lower limb lymphedema to allow patients to adopt the traditional Japanese 'seiza' sitting position.

摘要

Lymphatico-venous anastomosis (LVA) is established for treatment of lymphedema through construction of an artificial bypass between lymph vessels and veins. This allows perfusion of lymph in the extremities to the whole body, which improves lymph flow congestion caused by lymph node dissection in cancer treatment and reduces symptoms of lymphedema in the lower extremities.In conventional LVA, substantial improvement in the circumference of extremities can be achieved by constructing a bypass predominantly in the anterior part of the body in a supine position. However, if the functional goal is improved range of motion (ROM), bypass graft surgery in the posterior part of the body (i.e., the flexion side of joints) is likely to provide a better outcome.In this study, LVA in the posterior knee was performed to improve the range of motion of the knee joints and ankles in two patients with severe lymphedema. This allowed full bending of the knees in patients who were unable to adopt the "seiza" position, a traditional Japanese sitting position with fully bent knees.