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J Plast Reconstr Aesthet Surg. 2014 Apr;67(4):520-5. doi: 10.1016/j.bjps.2013.12.056. Epub 2014 Jan 8.

Suitable therapy options for sub-clinical and early-stage lymphoedema patients.

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Department of Plastic and Reconstructive Surgery, Chiba Cancer Center, Chiba City, Japan. Electronic address:
Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University, Chiba City, Japan.
Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital, Nankoku City, Japan.
Department of Plastic and Reconstructive Surgery, Chiba Cancer Center, Chiba City, Japan.
Clinical Research Center, Chiba University Hospital, Chiba City, Japan.



The best therapeutic approach for patients with sub-clinical lymphoedema and symptomatic early-stage lymphoedema has not been determined yet.


The prognosis of lymphatic function after lymphadenectomy for gynaecological cancer was observed in a cohort study of 192 lower limbs. Lymphatic function was evaluated by indocyanine green lymphography. Splash patterns were examined to determine if patients with this pattern tended to progress to symptomatic lymphoedema, and the efficacy of the compression therapy was also investigated. We also investigated the efficacy of lymphaticovenular anastomosis (LVA) in patients who exhibited a stardust pattern.


Patients with splash patterns on lymphography may progress to symptomatic lymphoedema with a significantly higher frequency compared with the others, with a relative ratio of 1.62. Compression therapy did not slow the progression of patients with splash patterns to stardust patterns. LVA for the patients who had recently shown stardust patterns eliminated the need for compression therapy in 44.8% of patients.


Patients with splash patterns should be followed up carefully for sub-clinical lymphoedema. However, there is no method to completely prevent these patients from developing stardust patterns associated with symptomatic lymphoedema. When patients become symptomatic, their lymphatic function may be improved by LVA. However, the limited effectiveness of this procedure should be clearly explained to patients before surgery.


Early-stage lymphoedema; Indocyanine green lymphography; Lymphaticovenular anastomosis; Sub-clinical lymphoedema

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