{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:36:11Z","timestamp":1772969771246,"version":"3.50.1"},"reference-count":42,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,9,30]],"date-time":"2019-09-30T00:00:00Z","timestamp":1569801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Lymph node flap transfer has gradually gained popularity for the treatment of upper and lower limb lymphedema. The aim of this study is to present the outcomes of an integrated treatment protocol based on double gastroepiploic lymph node flap (DG\u2010VLN) and active physiotherapy in patients affected by Stage II and III lower extremity lymphedema.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>All Stage II and III lower limb lymphedema patients operated between September 2015 and December 2017 were retrospectively identified and only those treated with an integrated approach of DG\u2010VLN flap and active physiotherapy were included. Outcomes were assessed clinically with limb circumference measurement and radiologically with lymphoscintigraphy. Flap viability was evaluated through indocyanine green lymphography. Lymphedema related quality of life was evaluated preop and at 1\u2009year follow up through LYMQOL questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixteen patients met inclusion criteria. Mean follow up was 26.2\u2009months. Significant reduction in lower limb volume was observed for all patients from pre to post intervention. At 3 months of follow up, the mean CRR was 42.4% at below knee (BK) level and 25.4% at above knee (AK) level. At 12\u2009months of follow up, the mean CRR was 58.3% at BK level (<jats:italic>p<\/jats:italic> =\u2009.001*) and 43.4% at AK level (<jats:italic>p<\/jats:italic> &lt;\u2009.04*). LYMQOL metrics showed significantly better scores in all domains.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with lower limb lymphedema can benefit from combined DG\u2010VLN flap and active physiotherapy, as this approach seem to fasten the onset of improvement and to have a positive impact on patients' quality of life.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30511","type":"journal-article","created":{"date-parts":[[2019,10,1]],"date-time":"2019-10-01T04:17:21Z","timestamp":1569903441000},"page":"679-687","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema"],"prefix":"10.1002","volume":"39","author":[{"given":"Michele","family":"Maruccia","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation University of Bari Aldo Moro  Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Pezzolla","sequence":"additional","affiliation":[{"name":"Division of Videolaparoscopic Surgery, Department of Emergency and Organ Transplantation University of Bari  Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonora","family":"Nacchiero","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation University of Bari Aldo Moro  Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrizia","family":"Dicillo","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neuroscience and Sensory Organs University of Bari \"Aldo Moro\"  Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Macchia","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neuroscience and Sensory Organs University of Bari \"Aldo Moro\"  Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piero","family":"Fiore","sequence":"additional","affiliation":[{"name":"Department of Basic Medical Sciences, Neuroscience and Sensory Organs University of Bari \"Aldo Moro\"  Bari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Giudice","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation University of Bari Aldo Moro  Bari 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