{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:57:53Z","timestamp":1790740673049,"version":"4.1.0"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"05","license":[{"start":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T00:00:00Z","timestamp":1717027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The treatment of breast cancer has seen great success in the recent decade. With longer survivorship, more attention is paid to function and aesthetics as integral treatment components. However, breast cancer-related lymphedema (BCRL) remains a significant complication. Immediate lymphatic reconstruction is an emerging technique to reduce the risk of BCRL, the Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) being the most widely used approach. Despite promising results, it is often difficult to find suitably sized recipient venules and perform the microanastomoses between mismatched vessels deep in the axilla. Moreover, high axillary venous pressure gradients and potential damage from radiotherapy may affect the long-term patency of the anastomoses. From an ergonomic point of view, performing lymphaticovenular anastomosis in the deep axilla may be challenging for the microsurgeon. In response to these limitations, we modified the technique by moving the lymphatic reconstruction distally\u2014terming it distally based LYMPHA (dLYMPHA). A total of 113 patients underwent mastectomy with axillary clearance in our institution from 2018 to 2021. Of these, 26 underwent subsequent dLYMPHA (Group 2), whereas 87 did not (Group 1). In total, 17.2% (15 patients) and 3.84% (1 patient) developed BCRL in Groups 1 and 2, respectively (p\u2009=\u20090.018). Lymphatics and recipient venules suitable for anastomoses can be reliably found in the distal upper limb with better size match. A distal modification achieves a more favorable lymphaticovenular pressure gradient, vessel match, and ergonomics while ensuring a comparably low BCRL rate.<\/jats:p>","DOI":"10.1055\/a-2336-0150","type":"journal-article","created":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T22:40:23Z","timestamp":1717108823000},"page":"504-509","source":"Crossref","is-referenced-by-count":8,"title":["Distally Based Lymphatic Microsurgical Preventive Healing Approach\u2014A Modification of the Classic Approach"],"prefix":"10.1055","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7924-5155","authenticated-orcid":false,"given":"Allen Wei-Jiat","family":"Wong","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive & Aesthetic Surgery Service, Sengkang General Hospital, Singapore"},{"name":"Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia Hui Shan","family":"Sim","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive & Aesthetic Surgery Service, Sengkang General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0363-3925","authenticated-orcid":false,"given":"Coeway Boulder","family":"Thing","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive & Aesthetic Surgery Service, Sengkang General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxuan","family":"Xu","sequence":"additional","affiliation":[{"name":"Toulouse School of Economics, Universit\u00e9 Toulouse 1 Capitole, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui Wen","family":"Chua","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Breast Service, Sengkang General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Ngaserin","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Breast Service, Sengkang General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shermaine","family":"Loh","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yee Onn","family":"Kok","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive & Aesthetic Surgery Service, Sengkang General Hospital, Singapore"},{"name":"Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia Jun","family":"Feng","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive & Aesthetic Surgery Service, Sengkang General Hospital, Singapore"},{"name":"Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan Woon Woon","family":"Pearlie","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive & Aesthetic Surgery Service, Sengkang General Hospital, Singapore"},{"name":"Department of Plastic Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7347-8713","authenticated-orcid":false,"given":"Benita Kiat-Tee","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Breast Service, Sengkang General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,8,6]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"e581","DOI":"10.1097\/SLA.0000000000003746","article-title":"Is immediate lymphatic reconstruction cost-effective?","volume":"274","author":"A R Johnson","year":"2021","journal-title":"Ann Surg"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"S234","DOI":"10.1097\/SAP.0000000000001864","article-title":"Lymphedema incidence after axillary lymph node dissection: quantifying the impact of radiation and the lymphatic microsurgical preventive healing approach","volume":"82","author":"A R Johnson","year":"2019","journal-title":"Ann Plast Surg"},{"issue":"09","key":"ref3","doi-asserted-by":"crossref","first-page":"2500","DOI":"10.1245\/s10434-011-1624-4","article-title":"Surgical prevention of arm lymphedema after breast cancer treatment","volume":"18","author":"F M 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