{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T17:52:57Z","timestamp":1774806777562,"version":"3.50.1"},"reference-count":55,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,8,26]],"date-time":"2020-08-26T00:00:00Z","timestamp":1598400000000},"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":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There is no consensus on the appropriate treatment of lymphedema. Proposed techniques include lymphaticovenous anastomosis (LVA), vascularized lymph nodes transfer (VLNT), and suction lipectomy (SL). The benefit of combined procedures has also been postulated. In this prospective study, a combined protocol is proposed as an alternative to single\u2010procedure strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2016 and October 2018, we enrolled patients with secondary lymphedema of lower limbs, stage II\u2010III according to the International Society of Lymphology, progressive swelling and skin tonicity &gt;60. Thirty\u2010seven consecutive patients were dichotomized into group I, undergoing VLNT, and group II undergoing VLNT and LVA. Gastroepiploic lymphnode flap was harvested through laparoscopy, and in the same operation, LVAs were performed in group II on the basis of indocyanine green lymphography and patent blue findings. Two weeks later, SL was performed in all the patients. Patients were prospectively evaluated through clinical examination, circumference measurement, and skin tonicity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The average follow\u2010up was 2 \u00b1\u20090.8\u2009years. The first consecutive 21 patients were treated with VLNT followed by SL. The next 16 patients underwent combined VLNT and LVA, followed by SL. A mean of 2.4 LVAs were performed. A significant difference in the postoperative circumference measurements was found overall (<jats:italic>p<\/jats:italic> &lt;\u2009.05): 52.6 \u00b1\u200918.9 above the knee, 42.9 \u00b1\u200925 below the knee, 36.2 \u00b1\u200937 at foot. The postoperative tonicity dropped by 12.7 \u00b1\u20096.3% (<jats:italic>p<\/jats:italic> &lt;\u2009.05). The episodes of cellulitis significantly decreased to 0.1 \u00b1\u20090.3 (<jats:italic>p<\/jats:italic> &lt;\u2009.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>LVA, VLNT, and SL can be integrated together in a combined approach, in synergy to enhance the outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.30641","type":"journal-article","created":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T16:21:44Z","timestamp":1599063704000},"page":"34-43","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["A prospective study on combined lymphedema surgery: Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3014-2419","authenticated-orcid":false,"given":"Giuseppe","family":"Di Taranto","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery China Medical University Hospital  Taichung Taiwan"},{"name":"Department of Plastic Surgery University of Rome La Sapienza Department of Surgery  Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6418-2873","authenticated-orcid":false,"given":"Alberto","family":"Bolletta","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery China Medical University Hospital  Taichung Taiwan"},{"name":"Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit Universita degli Studi di Sassari  Sassari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shih\u2010Heng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery Taoyuan Chang Gung Memorial Hospital Linkou Main Branch  Taoyuan Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9105-1839","authenticated-orcid":false,"given":"Luigi","family":"Losco","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery China Medical University Hospital  Taichung Taiwan"},{"name":"Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia Universit\u00e0 degli Studi di Pisa Facolta di Medicina e Chirurgia  Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6094-5159","authenticated-orcid":false,"given":"Rossella","family":"Elia","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery China Medical University Hospital  Taichung Taiwan"},{"name":"Universita degli Studi di Bari Dipartimento Emergenza e Trapianti di Organi Division of Plastic and Reconstructive Surgery  Bari 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