Research progress of lymphaticovenous anastomosis in treatment of severe extremity trauma_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Xiao ^1,2 , LIU Zhijin ¹ , ZHOU Ruowen ^1,2 , LI Jianning ¹ , JU Wen ¹ , JU Jihui ¹ ,  HOU Ruixing ^1,2

1. Department of Joint Surgery, Suzhou Ruihua Orthopedic Hospital, Suzhou Jiangsu, 215104, P. R. China;
2. Suzhou Medical College of Soochow University, Suzhou Jiangsu, 215123, P. R. China;

Corresponding?author：

HOU Ruixing, Email: huarui1000@163.com

Keywords：

Secondary lymphedema; severe extremity trauma; lymphaticovenous anastomosis

DOI：

10.7507/1002-1892.202601131

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To review the research progress of lymphaticovenous anastomosis (LVA) in the treatment of severe extremity trauma and prospect its clinical application prospects. Methods Based on the existing literature, this study elaborated on the pathological mechanism and adverse effects of post-traumatic lymphatic drainage disorder, systematically sorted out the clinical research cases and therapeutic effects of LVA in the treatment of severe extremity trauma, and analyzed the limitations of the current clinical application of LVA. Results Severe extremity trauma can cause extensive disruption of superficial and deep lymphatic vessels, which exacerbates post-traumatic limb swelling in the early stage and easily progresses to chronic lymphedema in the long term, thus hindering the process of wound repair and reducing patients’ quality of life. Existing small-sample clinical studies and cases have confirmed that LVA can effectively reconstruct the lymphatic drainage pathway and exert a definite therapeutic effect on post-traumatic lymphedema. However, this technique is still in the early stage of clinical application, with unsolved problems including no consensus on the optimal application timing, incompletely elucidated underlying mechanism of action, and relatively high technical threshold. Conclusion LVA exhibits important clinical application potential in the treatment of severe extremity trauma, and can serve as an effective method for clinically controlling limb swelling caused by post-traumatic lymphatic stasis. In the future, research should focus on the early therapeutic application of LVA for extremity trauma, clarify its optimal intervention timing and indications, optimize the treatment regimen by combining with traditional detumescence measures, so as to further enhance its clinical value in the treatment of severe extremity trauma.

Citation： HUANG Xiao, LIU Zhijin, ZHOU Ruowen, LI Jianning, JU Wen, JU Jihui, HOU Ruixing. Research progress of lymphaticovenous anastomosis in treatment of severe extremity trauma. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(6): 990-994. doi: 10.7507/1002-1892.202601131 Copy

1.	中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科分會外固定與肢體重建學組, 中國醫師協會創傷外科醫師分會骨與關節損傷學組. 肢體創傷后水腫管理指南 (2025). 中華創傷骨科雜志, 2025, 27(2): 93-105.
2.	巨積輝, 趙剛, 芮永軍, 等. 手部脫套傷的分型與撕脫皮膚急診修復專家共識. 中華顯微外科雜志, 2025, 48(2): 121-134.
3.	Ciudad P, Huayllani MT, Forte AJ, et al. Vascularized lymph node transfer for the treatment of posttraumatic lower extremity lymphedema: A preliminary report. Indian J Plast Surg, 2022, 55(1): 97-101.
4.	Szczesny G, Olszewski WL. The pathomechanism of posttraumatic edema of lower limbs: Ⅰ. The effect of extravasated blood, bone marrow cells, and bacterial colonization on tissues, lymphatics, and lymph nodes. J Trauma, 2002, 52(2): 315-322.
5.	Szczesny G, Olszewski WL. The pathomechanism of posttraumatic edema of the lower limbs: Ⅱ—Changes in the lymphatic system. J Trauma, 2003, 55(2): 350-354.
6.	Lurie F, Malgor RD, Carman T, et al. The American Venous Forum, American Vein and Lymphatic Society and the Society for Vascular Medicine expert opinion consensus on lymphedema diagnosis and treatment. Phlebology, 2022, 37(4): 252-266.
7.	Renò F, Sabbatini M. Breaking a vicious circle: Lymphangiogenesis as a new therapeutic target in wound healing. Biomedicines, 2023, 11(3): 656. doi: 10.3390/biomedicines11030656.
8.	Wagner JM, Grolewski V, Reinkemeier F, et al. Posttraumatic lymphedema after open fractures of the lower extremity—A retrospective cohort analysis. J Pers Med, 2021, 11(11): 1077. doi: 10.3390/jpm11111077.
9.	Mello DF, Assef JC, Helene Jr A. Lymphoscintigraphic evaluation of lymphatic circulation in victims of circumferential degloving injuries of the lower limbs. Rev Col Bras Cir, 2022, 49: e20222981. doi: 10.1590/0100-6991e-20222981.
10.	Van Zanten MC, Mistry RM, Suami H, et al. The lymphatic response to injury with soft-tissue reconstruction in high-energy open tibial fractures of the lower extremity. Plast Reconstr Surg, 2017, 139(2): 483-491.
11.	Zampell JC, Aschen S, Weitman ES, et al. Regulation of adipogenesis by lymphatic fluid stasis: Part Ⅰ. Adipogenesis, fibrosis, and inflammation. Plast Reconstr Surg, 2012, 129(4): 825-834.
12.	Ly CL, Kataru RP, Mehrara BJ. Inflammatory manifestations of lymphedema. Int J Mol Sci, 2017, 18(1): 171. doi: 10.3390/ijms18010171.
13.	Farncombe M, Daniels G, Cross L. Lymphedema-the seemingly forgotten complication. J Pain Symptom Manage, 1994, 9(4): 269-276.
14.	Liao CD, Kuruvilla AS, Krajewski A. A scoping literature review of post-traumatic lymphedema: Where are we now? J Plast Reconstr Aesthet Surg, 2022, 75(7): 2387-2440.
15.	Cheng MH, Huang JJ, Wu CW, et al. The mechanism of vascularized lymph node transfer for lymphedema: Natural lymphaticovenous drainage. Plast Reconstr Surg, 2014, 133(2): 192E-198E.
16.	Yamamoto T, Iida T, Yoshimatsu H, et al. Lymph flow restoration after tissue replantation and transfer: Importance of lymph axiality and possibility of lymph flow reconstruction without lymph node transfer or lymphatic anastomosis. Plast Reconstr Surg, 2018, 142(3): 796-804.
17.	O’Brien BM, Shafiroff BB. Microlymphaticovenous and resectional surgery in obstructive lymphedema. World J Surg, 1979, 3(1): 3-15,121-123.
18.	O’Brien BM, Sykes PJ, Threlfall GN, et al. Micro-lymphaticovenous anastomoses for obstructive lymphedema. Plast Reconstr Surg, 1977, 60(2): 197-211.
19.	Koshima I, Inagawa K, Urushibara K, et al. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg, 2000, 16(6): 437-442.
20.	Mihara M, Hara H, Todokoro T, et al. The effect of lymphatico-venous anastomosis for an intractable ulcer at the lower leg in a marked obese patient. Microsurgery, 2014, 34(1): 64-67.
21.	Dahl VA, Tadisina KK, Xu KY. Limb salvage and treatment of posttraumatic lymphedema in a mangled lower extremity. Prs-glob Open, 2024, 12(10): e6209. doi: 10.1097/GOX.0000000000006209.
22.	Scaglioni MF, Meroni M, Fritsche E. Soft tissue defect reconstruction and lymphatic complications prevention: The lymphatic flow-through (LyFT) concept. Medicina, 2022, 58(4): 509. doi: 10.3390/medicina58040509.
23.	Scaglioni MF, Meroni M, Fritsche E. Pedicled superficial circumflex iliac artery perforator flap combined with lymphovenous anastomosis between the recipient site lymphatic vessels and flap superficial veins for reconstruction of groin/thigh tissue defect and creation of lymph flow-through to reduce lymphatic complications: A report of preliminary results. Microsurgery, 2023, 43(1): 44-50.
24.	Pereira N, O?ate V, Roa R. A comprehensive approach to posttraumatic lymphedema surgical treatment. Arch Plast Surg, 2023, 50(4): 422-431.
25.	Abdelfattah U, Elsawy GA, Nafea SA, et al. Physiological restoration of lymphatic flow in posttraumatic extremity lymphedema using lymphatic flaps. J Reconstr Microsurg, 2026, 42(3): 204-213.
26.	Provencher AM, Giguère-Lemieux é, Croteau é, et al. The use of manual lymphatic drainage on clinical presentation of musculoskeletal injuries: A systematic review. Complement Ther Clin Pract, 2021, 45: 101469. doi: 10.1016/j.ctcp.2021.101469.
27.	Becker C, Arrivé L, Mangiameli G, et al. Post-traumatic massive hand lymphedema fully cured by vascularized lymph node flap transfer. SICOT J, 2018, 4: 53. doi: 10.1051/sicotj/2018049.
28.	Gazyakan E, Bigdeli AK, Kneser U, et al. Chimeric thoracodorsal lymph node flap with a perforator-based fasciocutaneous skin island for treatment of lower extremity lymphedema: A case report. Microsurgery, 2020, 40(7): 792-796.
29.	Schoenle P, Gazyakan E, Kremer T, et al. The chimeric versatility of the subscapular system revisited: Backup options, coverage for bone transplants and vascularized lymph nodes. Plast Reconstr Surg Glob Open, 2018, 6(5): e1765. doi: 10.1097/GOX.0000000000001765.
30.	Pereira N, Cámbara á, Kufeke M, et al. Post-traumatic lymphedema treatment with superficial circumflex iliac artery perforator lymphatic free flap: A case report. Microsurgery, 2019, 39(4): 354-359.
31.	Pereira N, Cambara á, Kufeke M, et al. Prevention and treatment of posttraumatic lymphedema by soft tissue reconstruction with lymphatic vessels free flap: An observational study. Ann Plast Surg, 2021, 86(4): 434-439.
32.	Yamamoto T, Yamamoto N, Kageyama T, et al. Lymph-interpositional-flap transfer (LIFT) based on lymph-axiality concept: Simultaneous soft tissue and lymphatic reconstruction without lymph node transfer or lymphatic anastomosis. J Plast Reconstr Aesthet Surg, 2021, 74(10): 2604-2612.
33.	Raju A, Chang DW. Vascularized lymph node transfer for treatment of lymphedema: a comprehensive literature review. Ann Surg, 2015, 261(5): 1013-1023.
34.	Zheng Y, Cong L, Zhao L, et al. Lymphatic platelet thrombosis limits bone repair by precluding lymphatic transporting DAMPs. Nat Commun, 2025, 16(1): 829. doi: 10.21203/RS.3.RS-3474507/V1.
35.	Kataru RP, Jung K, Jang C, et al. Critical role of CD11b+ macrophages and VEGF in inflammatory lymphangiogenesis, antigen clearance, and inflammation resolution. Blood, 2009, 113(22): 5650-5659.

1. 中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科分會外固定與肢體重建學組, 中國醫師協會創傷外科醫師分會骨與關節損傷學組. 肢體創傷后水腫管理指南 (2025). 中華創傷骨科雜志, 2025, 27(2): 93-105.
2. 巨積輝, 趙剛, 芮永軍, 等. 手部脫套傷的分型與撕脫皮膚急診修復專家共識. 中華顯微外科雜志, 2025, 48(2): 121-134.
3. Ciudad P, Huayllani MT, Forte AJ, et al. Vascularized lymph node transfer for the treatment of posttraumatic lower extremity lymphedema: A preliminary report. Indian J Plast Surg, 2022, 55(1): 97-101.
4. Szczesny G, Olszewski WL. The pathomechanism of posttraumatic edema of lower limbs: Ⅰ. The effect of extravasated blood, bone marrow cells, and bacterial colonization on tissues, lymphatics, and lymph nodes. J Trauma, 2002, 52(2): 315-322.
5. Szczesny G, Olszewski WL. The pathomechanism of posttraumatic edema of the lower limbs: Ⅱ—Changes in the lymphatic system. J Trauma, 2003, 55(2): 350-354.
6. Lurie F, Malgor RD, Carman T, et al. The American Venous Forum, American Vein and Lymphatic Society and the Society for Vascular Medicine expert opinion consensus on lymphedema diagnosis and treatment. Phlebology, 2022, 37(4): 252-266.
7. Renò F, Sabbatini M. Breaking a vicious circle: Lymphangiogenesis as a new therapeutic target in wound healing. Biomedicines, 2023, 11(3): 656. doi: 10.3390/biomedicines11030656.
8. Wagner JM, Grolewski V, Reinkemeier F, et al. Posttraumatic lymphedema after open fractures of the lower extremity—A retrospective cohort analysis. J Pers Med, 2021, 11(11): 1077. doi: 10.3390/jpm11111077.
9. Mello DF, Assef JC, Helene Jr A. Lymphoscintigraphic evaluation of lymphatic circulation in victims of circumferential degloving injuries of the lower limbs. Rev Col Bras Cir, 2022, 49: e20222981. doi: 10.1590/0100-6991e-20222981.
10. Van Zanten MC, Mistry RM, Suami H, et al. The lymphatic response to injury with soft-tissue reconstruction in high-energy open tibial fractures of the lower extremity. Plast Reconstr Surg, 2017, 139(2): 483-491.
11. Zampell JC, Aschen S, Weitman ES, et al. Regulation of adipogenesis by lymphatic fluid stasis: Part Ⅰ. Adipogenesis, fibrosis, and inflammation. Plast Reconstr Surg, 2012, 129(4): 825-834.
12. Ly CL, Kataru RP, Mehrara BJ. Inflammatory manifestations of lymphedema. Int J Mol Sci, 2017, 18(1): 171. doi: 10.3390/ijms18010171.
13. Farncombe M, Daniels G, Cross L. Lymphedema-the seemingly forgotten complication. J Pain Symptom Manage, 1994, 9(4): 269-276.
14. Liao CD, Kuruvilla AS, Krajewski A. A scoping literature review of post-traumatic lymphedema: Where are we now? J Plast Reconstr Aesthet Surg, 2022, 75(7): 2387-2440.
15. Cheng MH, Huang JJ, Wu CW, et al. The mechanism of vascularized lymph node transfer for lymphedema: Natural lymphaticovenous drainage. Plast Reconstr Surg, 2014, 133(2): 192E-198E.
16. Yamamoto T, Iida T, Yoshimatsu H, et al. Lymph flow restoration after tissue replantation and transfer: Importance of lymph axiality and possibility of lymph flow reconstruction without lymph node transfer or lymphatic anastomosis. Plast Reconstr Surg, 2018, 142(3): 796-804.
17. O’Brien BM, Shafiroff BB. Microlymphaticovenous and resectional surgery in obstructive lymphedema. World J Surg, 1979, 3(1): 3-15,121-123.
18. O’Brien BM, Sykes PJ, Threlfall GN, et al. Micro-lymphaticovenous anastomoses for obstructive lymphedema. Plast Reconstr Surg, 1977, 60(2): 197-211.
19. Koshima I, Inagawa K, Urushibara K, et al. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg, 2000, 16(6): 437-442.
20. Mihara M, Hara H, Todokoro T, et al. The effect of lymphatico-venous anastomosis for an intractable ulcer at the lower leg in a marked obese patient. Microsurgery, 2014, 34(1): 64-67.
21. Dahl VA, Tadisina KK, Xu KY. Limb salvage and treatment of posttraumatic lymphedema in a mangled lower extremity. Prs-glob Open, 2024, 12(10): e6209. doi: 10.1097/GOX.0000000000006209.
22. Scaglioni MF, Meroni M, Fritsche E. Soft tissue defect reconstruction and lymphatic complications prevention: The lymphatic flow-through (LyFT) concept. Medicina, 2022, 58(4): 509. doi: 10.3390/medicina58040509.
23. Scaglioni MF, Meroni M, Fritsche E. Pedicled superficial circumflex iliac artery perforator flap combined with lymphovenous anastomosis between the recipient site lymphatic vessels and flap superficial veins for reconstruction of groin/thigh tissue defect and creation of lymph flow-through to reduce lymphatic complications: A report of preliminary results. Microsurgery, 2023, 43(1): 44-50.
24. Pereira N, O?ate V, Roa R. A comprehensive approach to posttraumatic lymphedema surgical treatment. Arch Plast Surg, 2023, 50(4): 422-431.
25. Abdelfattah U, Elsawy GA, Nafea SA, et al. Physiological restoration of lymphatic flow in posttraumatic extremity lymphedema using lymphatic flaps. J Reconstr Microsurg, 2026, 42(3): 204-213.
26. Provencher AM, Giguère-Lemieux é, Croteau é, et al. The use of manual lymphatic drainage on clinical presentation of musculoskeletal injuries: A systematic review. Complement Ther Clin Pract, 2021, 45: 101469. doi: 10.1016/j.ctcp.2021.101469.
27. Becker C, Arrivé L, Mangiameli G, et al. Post-traumatic massive hand lymphedema fully cured by vascularized lymph node flap transfer. SICOT J, 2018, 4: 53. doi: 10.1051/sicotj/2018049.
28. Gazyakan E, Bigdeli AK, Kneser U, et al. Chimeric thoracodorsal lymph node flap with a perforator-based fasciocutaneous skin island for treatment of lower extremity lymphedema: A case report. Microsurgery, 2020, 40(7): 792-796.
29. Schoenle P, Gazyakan E, Kremer T, et al. The chimeric versatility of the subscapular system revisited: Backup options, coverage for bone transplants and vascularized lymph nodes. Plast Reconstr Surg Glob Open, 2018, 6(5): e1765. doi: 10.1097/GOX.0000000000001765.
30. Pereira N, Cámbara á, Kufeke M, et al. Post-traumatic lymphedema treatment with superficial circumflex iliac artery perforator lymphatic free flap: A case report. Microsurgery, 2019, 39(4): 354-359.
31. Pereira N, Cambara á, Kufeke M, et al. Prevention and treatment of posttraumatic lymphedema by soft tissue reconstruction with lymphatic vessels free flap: An observational study. Ann Plast Surg, 2021, 86(4): 434-439.
32. Yamamoto T, Yamamoto N, Kageyama T, et al. Lymph-interpositional-flap transfer (LIFT) based on lymph-axiality concept: Simultaneous soft tissue and lymphatic reconstruction without lymph node transfer or lymphatic anastomosis. J Plast Reconstr Aesthet Surg, 2021, 74(10): 2604-2612.
33. Raju A, Chang DW. Vascularized lymph node transfer for treatment of lymphedema: a comprehensive literature review. Ann Surg, 2015, 261(5): 1013-1023.
34. Zheng Y, Cong L, Zhao L, et al. Lymphatic platelet thrombosis limits bone repair by precluding lymphatic transporting DAMPs. Nat Commun, 2025, 16(1): 829. doi: 10.21203/RS.3.RS-3474507/V1.
35. Kataru RP, Jung K, Jang C, et al. Critical role of CD11b+ macrophages and VEGF in inflammatory lymphangiogenesis, antigen clearance, and inflammation resolution. Blood, 2009, 113(22): 5650-5659.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress of lymphaticovenous anastomosis in treatment of severe extremity trauma

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content