{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:49:12Z","timestamp":1790106552902,"version":"4.0.1"},"reference-count":22,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T00:00:00Z","timestamp":1621036800000},"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":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Patients presenting with chronic wounds in venous insufficiency often represent a challenge, like other conditions, like lymphatic impairment, may complicate the wound healing process. The purpose of this report is to highlight how the treatment of lymphatic impairment may be beneficial in patients affected by chronic ulcers with concomitant venous insufficiency. We present the case of a 78\u2010year\u2010old woman affected by chronic venous insufficiency (CVI) with long\u2010lasting ulcers secondary to sclerosing agents treatment for varicose veins. The patient's condition was refractory to both conservative and surgical treatment. Since the patient also presented with severe lymphorrhea, with a significant amount of daily secretion, ICG\u2010lymphography was performed subcutaneously, to visualize the pathway of lymphatic drainage and leakage. It also allowed marking on the skin the exact location of lymphatic vessels distally to the wound area. Hence, two lymphatico\u2010venous anastomoses were performed between the two major collecting lymphatic vessels and two subcutaneous veins of adequate size. The postoperative course was uneventful and the procedure allowed for immediate resolution of lymphatic leakage and complete wound healing within 2\u2009weeks with no recurrence in the follow\u2010up time of 1.5\u2009years. Based on the outcomes of this case, it is possible to consider the use of CVI treatment and lymphedema surgery as a combined approach to complicated cases of long\u2010standing venous ulcers with lymphorrhea.<\/jats:p>","DOI":"10.1002\/micr.30753","type":"journal-article","created":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T09:07:14Z","timestamp":1621069634000},"page":"574-578","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Lymphatico\u2010venous anastomosis in chronic ulcer with venous insufficiency: A case report"],"prefix":"10.1002","volume":"41","author":[{"given":"Emanuele","family":"Cigna","sequence":"first","affiliation":[{"name":"Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1755-4950","authenticated-orcid":false,"given":"Diletta Maria","family":"Pierazzi","sequence":"additional","affiliation":[{"name":"Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Sereni","sequence":"additional","affiliation":[{"name":"Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Marcasciano","sequence":"additional","affiliation":[{"name":"Plastic Surgery Unit, Department of surgery Sapienza University of Rome  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9105-1839","authenticated-orcid":false,"given":"Luigi","family":"Losco","sequence":"additional","affiliation":[{"name":"Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6418-2873","authenticated-orcid":false,"given":"Alberto","family":"Bolletta","sequence":"additional","affiliation":[{"name":"Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,15]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4632.2004.02456.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.25583"},{"issue":"1","key":"e_1_2_7_4_1","first-page":"1","article-title":"Microlymphatics of human skin","volume":"12","author":"Bollinger A.","year":"1993","journal-title":"International Journal of Microcirculation, Clinical and Experimental"},{"issue":"2","key":"e_1_2_7_5_1","first-page":"60","article-title":"Lymphatic microangiopathy: A complication of severe chronic venous incompetence (CVI)","volume":"15","author":"Bollinger 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