Peri-operative care for patients undergoing lymphatico-venular anastomosis: A systematic review

Publication date: Available online 27 November 2016
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): H. Winters, H.J.P. Tielemans, P.N. Sprangers, D.J.O. Ulrich
BackgroundLymphatico-venular anastomosis (LVA) is a microsurgical procedure that involves the anastomosis of a functional lymphatic channel to a venule. While peri-operative care might be an important contributor to the success of this technique, evidence about optimal peri-operative care seems limited. This review aims to summarize the peri-operative methods used by authors reporting on LVA.MethodsA systematic search of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Peri-operative care used by authors was summarized and listed in a pre-defined form. Studies were also graded on quality of evidence by the GRADE system and a lymphedema surgery specific system.ResultsTwenty-two studies were identified describing peri-operative measures. While most authors were sparse in their description of peri-operative management, most recommended conventional compression therapy initiated one to four weeks after surgery. Prophylactic antibiotics, elevation of the affected limb, bandaging, low molecular weight heparin, prostaglandin E1, and manual pressure therapy were also described. The quality of evidence of the studies included was low on average.ConclusionWhile super microsurgical LVAs are gaining in popularity, there are no high quality prospective trials evaluating these new techniques and the description of peri-operative management is scarce. Out of the available studies, a peri-operative management consisting of prophylactic antibiotics, elevation of the affected limb during night and hospital stay, and compression therapy 4 weeks post-surgery for six months seems to be preferred. Future studies should describe a detailed peri-operative protocol to allow for a better comparison between study results, and to determine optimal peri-operative recommendations.



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