Beijing Jishuitan Hospital: Supermicrosurgical LVA for Severe Secondary Upper Extremity Lymphedema

🏥 Recently, the expert surgical team led by Dr. Wu Jingheng and Dr. Li Pengcheng at the Department of Hand Surgery, Beijing Jishuitan Hospital, successfully treated a complex case of severe secondary upper extremity lymphedema.

📋 The clinical etiology stemmed from a radical mastectomy performed 20 years ago. The inevitable disruption of the axillary lymphatic network led to a progressive, 10-year accumulation of protein-rich lymphatic fluid and severe tissue fibrosis.

📉 As indicated by the attached preoperative measurements, the affected limb had grown to nearly twice the size of the healthy limb. Traditional conservative management, such as compression therapy, had reached its limits and could no longer halt the disease progression.

💡 To address the root anatomical blockage rather than merely managing symptoms, the surgical team opted for Lymphovenous Anastomosis (LVA). This advanced physiological reconstruction creates a direct bypass, rerouting congested lymphatic fluid into adjacent venules to permanently restore drainage.

🔬 Serving as a national microsurgery training center, the team utilized Indocyanine Green (ICG) near-infrared lymphography prior to incision. This crucial diagnostic step allowed for real-time visualization of lymphatic flow, enabling surgeons to precisely map and isolate viable lymphatic vessels amidst dense fibrotic tissue.

🪡 As seen in the attached microscopic view, executing LVA requires top-tier supermicrosurgical expertise. Operating under a surgical microscope at nearly 30x magnification, the surgical team navigated sub-millimeter anatomical structures over a demanding 7-hour period.

⏱️ The team successfully completed multiple ultra-fine anastomoses between lymphatic vessels and micro-veins, effectively re-establishing the physiological lymphatic drainage pathway.

🩸 On the first postoperative day, the patient experienced a significant decrease in limb tension and visible volume reduction. This successful LVA procedure demonstrates the hospital's comprehensive capability in managing complex, end-stage reconstructive challenges through cutting-edge supermicrosurgery.