{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T12:42:18Z","timestamp":1792500138946,"version":"4.5.0"},"reference-count":45,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Lymphaticovenous anastomosis (LVA) is an established microsurgical treatment for lymphedema, but predictors of intraoperative vessel characteristics and immediate anastomosis patency remain unclear. This study investigated associations between preoperative patient and disease factors and intraoperative findings during LVA surgery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this prospective international multicenter study, 183 patients undergoing 426 LVAs were included. Preoperative patient and disease characteristics were recorded. Surgeons documented intraoperative findings using a standardized semiquantitative grading form, assessing lymphatic vessel function and fibrosis, and venous backflow and patency of the immediate anastomosis using intraoperative indocyanine green lymphography (ICG\u2010L). Accuracy of preoperative ICG\u2010L markings was also assessed. Associations between preoperative variables and intraoperative findings were analyzed using cumulative link mixed models and negative binomial regression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The upper extremity had markedly less lymphatic vessel fibrosis (OR: 10.23, 95% CI: 2.27\u201345.99,\n p<\/jats:italic>\n \u2009=\u20090.002) and greater venous backflow (OR: 0.46 for reduced backflow, 95% CI: 0.22\u20130.97,\n p<\/jats:italic>\n \u2009=\u20090.041). Increased age correlated with more accurate ICG\u2010L markings (OR: 1.04 per year, 95% CI: 1.00\u20131.08,\n p<\/jats:italic>\n \u2009=\u20090.048) and greater surgeon confidence in immediate LVA patency (OR: 1.02 per year, 95% CI: 1.00\u20131.05,\n p<\/jats:italic>\n \u2009=\u20090.028). Prior radical lymph node dissection reduced surgeon confidence in LVA patency (OR: 0.40, 95% CI: 0.16\u20130.97,\n p<\/jats:italic>\n \u2009=\u20090.042). Body mass index (BMI)\u2009>\u200930 showed a trend toward more venous backflow. Increased patient age (IRR: 1.03 per year, 95% CI: 1.00\u20131.07,\n p<\/jats:italic>\n \u2009=\u20090.026) and lower extremity location (upper\u2010 vs. lower\u2010extremity IRR: 0.33, 95% CI: 0.11\u20130.87,\n p<\/jats:italic>\n \u2009=\u20090.020) were associated with more preoperative erysipelas infections. Lymphedema stage (0\u20132b), etiology and duration, gender, and adjuvant therapy had no significant association with intraoperative findings.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This multicenter study identified patient age and lymphedema location as factors associated with intraoperative findings in LVA surgery, including infection frequency, lymphatic vessel fibrosis, venous backflow, and surgeon\u2010reported patency. Lymphedema stage (0\u20132b), etiology, and duration showed no significant associations.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n ISRCTN registry number: 72662721<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/micr.70296","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T11:47:53Z","timestamp":1792496873000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient and Disease Factors Linked to Intraoperative Findings in Lymphaticovenous Anastomosis Surgery for Lymphedema: An International Multicenter Study"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4781-7507","authenticated-orcid":false,"given":"Tinna H.","family":"Arnardottir","sequence":"first","affiliation":[{"name":"Department of Plastic and Maxillofacial Surgery Uppsala University Hospital Uppsala Sweden"},{"name":"Department of Surgical Sciences, Faculty of Medicine Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2905-653X","authenticated-orcid":false,"given":"Alieske","family":"Kleeven","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery Maastricht University Medical Center Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmine M. J.","family":"Jonis","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery Maastricht University Medical Center Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9767-134X","authenticated-orcid":false,"given":"Villiam V.","family":"Kildal","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, Section of Anesthesiology and Intensive Care Karolinska Institutet, S\u00f6dersjukhuset Stockholm Sweden"},{"name":"Department of Perioperative Care and Intensive Care S\u00f6dersjukhuset Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7027-4080","authenticated-orcid":false,"given":"Susanna","family":"Kauhanen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Maxillofacial Surgery Uppsala University Hospital Uppsala Sweden"},{"name":"Department of Plastic and Reconstructive Surgery Helsinki University Hospital Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanneke J. P.","family":"Tielemans","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0616-9566","authenticated-orcid":false,"given":"Shan Shan","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Hand Surgery Maastricht University Medical Center Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5387-6343","authenticated-orcid":false,"given":"Maria","family":"Mani","sequence":"additional","affiliation":[{"name":"Department of Plastic and Maxillofacial Surgery Uppsala University Hospital Uppsala Sweden"},{"name":"Department of Surgical Sciences, Faculty of Medicine Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,20]]},"reference":[{"issue":"2","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"596","DOI":"10.21037\/gs.2020.03.20","article-title":"The Impact of Radiation on Lymphedema: A Review of the Literature","volume":"9","author":"Allam O.","year":"2020","journal-title":"Gland Surgery"},{"issue":"8","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1002\/jso.24170","article-title":"Lymphedema Surgery: Patient Selection and an Overview of Surgical Techniques","volume":"113","author":"Allen R. 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