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J Reconstr Microsurg 2019; 35(04): 306-314
DOI: 10.1055/s-0038-1675368
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Bioelectrical Impedance Analysis of Water Reduction in Lower-Limb Lymphedema by Lymphaticovenular Anastomosis

Yoshichika Yasunaga
1   Department of Plastic and Reconstructive Surgery, School of Medicine, Shinshu University, Matsumoto, Japan
,
Daisuke Yanagisawa
1   Department of Plastic and Reconstructive Surgery, School of Medicine, Shinshu University, Matsumoto, Japan
,
Erika Ohata
2   Division of Plastic Surgery, Toyama Nishi General Hospital, Toyama, Japan
,
Kiyoshi Matsuo
1   Department of Plastic and Reconstructive Surgery, School of Medicine, Shinshu University, Matsumoto, Japan
3   Matsuo Plastic and Oculoplastic Surgery Clinic, Hamamatsu, Japan
,
Shunsuke Yuzuriha
1   Department of Plastic and Reconstructive Surgery, School of Medicine, Shinshu University, Matsumoto, Japan
› Author Affiliations
Further Information

Publication History

12 May 2018

04 September 2018

Publication Date:
02 November 2018 (online)

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Abstract

Background Although lymphedema is fundamentally abnormal accumulation of excess water in the extracellular space, previous studies have evaluated the efficacy of physiological bypass surgery (lymphaticovenular anastomosis [LVA]) for lymphedema without measuring water volume. This study clarified the water reductive effect of LVA using bioelectrical impedance analysis (BIA).

Methods The efficacy of LVA for unilateral lower-limb lymphedema was evaluated using BIA in a retrospective cohort. The water volume of affected and unaffected legs was measured using multifrequency BIA before and after LVA. Preoperative measurements were undertaken after compression therapy for at least 3 months. The follow-up period after LVA was a minimum of 6 months.

Results Thirty consecutive patients with unilateral lower-limb lymphedema were enrolled. The mean water volume reduction of the affected leg by LVA (ΔLBW) was 0.86 L (standard deviation [SD]: 0.86, median: 0.65) with a mean number of 3.3 anastomoses (SD: 1.7). The mean reduction rate of edema was 45.1% (SD: 36.3). Multiple linear regression analysis revealed water volume difference between the affected and unaffected legs before LVA (excess LBW) as the strongest predictor of ΔLBW (R 2 = 0.759, p < 0.01; β = 0.500, p < 0.01).

Conclusion The LVA reduces the volume of accumulated body water in lower-limb lymphedema. As excess LBW most strongly predicted the amount of water volume reduction by LVA, body water volume measurement by BIA before LVA might identify patients with low excess LBW not expected to benefit from LVA, regardless of apparent differences in limb circumference.

Keywords

lymphedema - lymphaticovenular anastomosis - bioelectrical impedance analysis

Financial Disclosure

None of the authors have nothing to disclose.


Note

This study was presented in part at the 44th Annual Meeting of the Japanese Society of Reconstructive Microsurgery in Miyazaki, Japan, December 7, 2017.


 

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