{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T08:18:04Z","timestamp":1772957884975,"version":"3.50.1"},"reference-count":48,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Dysfunction of the lymphatic system causes lymphedema, a chronic disease that can lead to cellulitis. However, the optimal treatment modality for preventing cellulitis has not yet been established. This cohort study investigated the outcomes of cellulitis by treatment modality in lymphedema of the extremities. A meta-analysis was conducted to evaluate the change in frequency of cellulitis episodes according to the surgical procedure.<\/jats:p>\n                  <jats:p>This single-center retrospective cohort study included patients with extremity lymphedema who were treated at our department. We performed a comprehensive search of PubMed, Scopus, and Web of Science for studies published from 2000 to March 2025 with a primary outcome of change in the frequency of cellulitis episodes before and after treatment. The meta-analysis was conducted using a random-effects model.<\/jats:p>\n                  <jats:p>Our cohort study included 183 patients (nonsurgical treatment: 91; surgical treatment: 92). The change rate in frequency of cellulitis episodes before and after treatment increased by 27.0% in the nonsurgical group but decreased by 85.4% in the surgical group. Thirty-five studies, comprising 2,241 patients, were included in the meta-analysis. The mean reduction rates of cellulitis episodes per year before and after surgery were 84.8, 78.2, 80.6, and 87.6% for lymphaticovenous anastomosis, vascularized lymph node transfer (VLNT), liposuction, and combined surgery, respectively. Compared to before surgery, the number of cellulitis episodes per year was significantly reduced after lymphaticovenous anastomosis, VLNT, liposuction, and combined surgery, with standard mean differences of 0.91 (I\n                  2\u2009=\u200987%), 1.78 (I\n                  2\u2009=\u200994%), 0.68 (heterogeneity not calculable), and 1.66 (I\n                  2\u2009=\u200988%), respectively.<\/jats:p>\n                  <jats:p>The findings of this cohort study showed that surgical treatment was superior to nonsurgical treatment in preventing the development of cellulitis in extremity lymphedema. The meta-analysis results demonstrated that surgical procedures tailored to the severity of lymphedema can significantly reduce the development of cellulitis.<\/jats:p>","DOI":"10.1055\/a-2817-4764","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:07:42Z","timestamp":1771891662000},"source":"Crossref","is-referenced-by-count":0,"title":["Surgical Treatment for Extremity Lymphedema Reduces Frequency of Cellulitis Episodes: A Cohort Study and Meta-Analysis"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0761-4147","authenticated-orcid":false,"given":"Keisuke","family":"Shimbo","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Aoki","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1002\/micr.30115","article-title":"Do surgical interventions for limb lymphoedema reduce cellulitis attack frequency?","volume":"37","author":"A R Sharkey","year":"2017","journal-title":"Microsurgery"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1002\/jso.25525","article-title":"Clinical features, microbiological epidemiology and recommendations for management of cellulitis in extremity lymphedema","volume":"121","author":"J R Rodriguez","year":"2020","journal-title":"J Surg Oncol"},{"issue":"09","key":"ref4","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1007\/s11908-014-0422-0","article-title":"Recurrent cellulitis: risk factors, etiology, pathogenesis and treatment","volume":"16","author":"M P Chlebicki","year":"2014","journal-title":"Curr Infect Dis Rep"},{"issue":"05","key":"ref5","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1097\/JS9.0000000000000210","article-title":"Outcomes after microsurgical treatment of lymphedema: a systematic review and meta-analysis","volume":"109","author":"J N Meuli","year":"2023","journal-title":"Int J Surg"},{"issue":"17","key":"ref6","doi-asserted-by":"crossref","first-page":"5161","DOI":"10.3390\/jcm13175161","article-title":"Primary lymphedema multidisciplinary approach in patients affected by primary lower extremity lymphedema","volume":"13","author":"P Ciudad","year":"2024","journal-title":"J Clin Med"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"e613","DOI":"10.1097\/SLA.0000000000004588","article-title":"A single institution multi-disciplinary approach to power-assisted liposuction for the management of lymphedema","volume":"276","author":"M D Granoff","year":"2022","journal-title":"Ann Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.ejca.2021.02.043","article-title":"A meta-analysis of the efficacy of vascularised lymph node transfer in reducing limb volume and cellulitis episodes in patients with cancer treatment-related lymphoedema","volume":"151","author":"J Ward","year":"2021","journal-title":"Eur J Cancer"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.bjps.2023.11.035","article-title":"Comparative study of conservative treatment and lymphaticovenular anastomosis with compression therapy for early-stage breast cancer-related lymphoedema","volume":"88","author":"K Shimbo","year":"2024","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/j.jvsv.2023.06.013","article-title":"Conservative treatment versus lymphaticovenular anastomosis for early-stage lower extremity lymphedema","volume":"11","author":"K Shimbo","year":"2023","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"key":"ref11","first-page":"e29","article-title":"Treatment of lymphedema in patients with advanced cancer receiving palliative care: a single-center experience","volume":"24","author":"K Shimbo","year":"2024","journal-title":"Eplasty"},{"issue":"10","key":"ref12","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.jclinepi.2009.06.005","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"62","author":"D Moher","year":"2009","journal-title":"J Clin Epidemiol"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1002\/micr.20567","article-title":"Treatment of upper limb lymphedema with combination of liposuction, myocutaneous flap transfer, and lymph-fascia grafting: a preliminary study","volume":"29","author":"F Qi","year":"2009","journal-title":"Microsurgery"},{"issue":"11","key":"ref15","doi-asserted-by":"crossref","first-page":"1391","DOI":"10.1002\/bjs.9588","article-title":"Lymphaticovenular anastomosis to prevent cellulitis associated with lymphoedema","volume":"101","author":"M Mihara","year":"2014","journal-title":"Br J Surg"},{"issue":"02","key":"ref16","first-page":"85","article-title":"Liposuction of postmastectomy arm lymphedema decreases the incidence of erysipelas","volume":"49","author":"D Lee","year":"2016","journal-title":"Lymphology"},{"issue":"01","key":"ref17","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/s10549-016-3716-0","article-title":"A randomized control study of treating secondary stage II breast cancer-related lymphoedema with free lymph node transfer","volume":"156","author":"D Dionyssiou","year":"2016","journal-title":"Breast Cancer Res Treat"},{"issue":"22","key":"ref18","first-page":"4642","article-title":"Supramicrosurgical lymphatico-venular anastomosis (LVA) in treating lymphoedema: 36-months preliminary report","volume":"20","author":"P Gennaro","year":"2016","journal-title":"Eur Rev Med Pharmacol Sci"},{"issue":"07","key":"ref19","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1002\/micr.30200","article-title":"Serial two-year follow-up after lymphaticovenular anastomosis for the treatment of lymphedema","volume":"37","author":"K T Lee","year":"2017","journal-title":"Microsurgery"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1245\/s10434-016-5614-4","article-title":"Clinical and psychosocial outcomes of vascularized lymph node transfer for the treatment of upper extremity lymphedema after breast cancer therapy","volume":"24","author":"A Gratzon","year":"2017","journal-title":"Ann Surg Oncol"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1002\/bjs.10325","article-title":"Circumferential suction-assisted lipectomy in the treatment of primary and secondary end-stage lymphoedema of the leg","volume":"104","author":"D A Lamprou","year":"2017","journal-title":"Br J Surg"},{"issue":"06","key":"ref22","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1097\/SLA.0000000000002322","article-title":"Outcomes of lymphedema microsurgery for breast cancer-related lymphedema with or without microvascular breast reconstruction","volume":"268","author":"H Engel","year":"2018","journal-title":"Ann Surg"},{"issue":"12","key":"ref23","doi-asserted-by":"crossref","first-page":"e1923","DOI":"10.1097\/GOX.0000000000001923","article-title":"Comparisons of submental and groin vascularized lymph node flaps transfer for breast cancer-related lymphedema","volume":"6","author":"O A Ho","year":"2018","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"09","key":"ref24","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1055\/s-0038-1648220","article-title":"Cumulative experience in lymphovenous anastomosis for lymphedema treatment: the learning curve effect on the overall outcome","volume":"34","author":"N Pereira","year":"2018","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1097\/PRS.0000000000005870","article-title":"Comparison of outcomes between side-to-end and end-to-end lymphovenous anastomoses for early-grade extremity lymphedema","volume":"144","author":"F K AlJindan","year":"2019","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref26","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1002\/jso.25650","article-title":"Functional lymphatic reconstruction with the \u201cselected lymph node\u201d technique guided by a SPECT-CT lymphoscintigraphy","volume":"120","author":"D Dionyssiou","year":"2019","journal-title":"J Surg Oncol"},{"issue":"06","key":"ref27","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1016\/j.bjps.2019.01.029","article-title":"Postmastectomy upper limb lymphedema: Combined vascularized lymph node transfer and scar release with fat graft expedites surgical and patients' related outcomes. A retrospective comparative study","volume":"72","author":"M Maruccia","year":"2019","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"08","key":"ref28","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1002\/micr.30511","article-title":"Efficacy and early results after combining laparoscopic harvest of double gastroepiploic lymph node flap and active physiotherapy for lower extremity lymphedema","volume":"39","author":"M Maruccia","year":"2019","journal-title":"Microsurgery"},{"issue":"01","key":"ref29","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s10549-020-05839-4","article-title":"Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up","volume":"184","author":"S S Qiu","year":"2020","journal-title":"Breast Cancer Res Treat"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/jso.25602","article-title":"Long-term outcome of lower extremity lymphedema treated with vascularized lymph node flap transfer with or without venous complications","volume":"121","author":"S Koide","year":"2020","journal-title":"J Surg Oncol"},{"issue":"02","key":"ref31","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1002\/micr.30508","article-title":"Comparisons in long-term clinical outcomes among patients with upper or lower extremity lymphedema treated with diverse vascularized lymph node transfer","volume":"40","author":"P Ciudad","year":"2020","journal-title":"Microsurgery"},{"issue":"01","key":"ref32","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1002\/jso.25581","article-title":"Free gastroepiploic lymph nodes and omentum flap for treatment of lower limb ulcers in severe lymphedema: killing two birds with one stone","volume":"121","author":"G Di Taranto","year":"2020","journal-title":"J Surg Oncol"},{"issue":"01","key":"ref33","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1002\/jso.25607","article-title":"Vascularized gastroepiploic lymph node transfer significantly improves breast cancer-related lymphedema","volume":"121","author":"S R Mousavi","year":"2020","journal-title":"J Surg Oncol"},{"issue":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/PRS.0000000000007507","article-title":"Changing the paradigm: lymphovenous anastomosis in advanced stage lower extremity lymphedema","volume":"147","author":"H G Cha","year":"2021","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"e3354","DOI":"10.1097\/GOX.0000000000003354","article-title":"Long-term results of microvascular lymph node transfer: correlation of preoperative factors and operation outcome","volume":"9","author":"E H Rannikko","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"11","key":"ref36","doi-asserted-by":"crossref","first-page":"3089","DOI":"10.3390\/jcm11113089","article-title":"Lymphaticovenous anastomosis for treating secondary lower limb lymphedema in older patients-a retrospective cohort study","volume":"11","author":"J C Yang","year":"2022","journal-title":"J Clin Med"},{"issue":"05","key":"ref37","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1097\/SAP.0000000000003023","article-title":"A systematic stepwise method to perform a supermicrosurgical lymphovenous anastomosis","volume":"88","author":"J R Rodriguez","year":"2022","journal-title":"Ann Plast Surg"},{"issue":"05","key":"ref38","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1002\/micr.30855","article-title":"Combined lymph node transfer and suction-assisted lipectomy in lymphedema treatment: a prospective study","volume":"42","author":"A Bolletta","year":"2022","journal-title":"Microsurgery"},{"issue":"09","key":"ref39","doi-asserted-by":"crossref","first-page":"3129","DOI":"10.1016\/j.bjps.2022.04.105","article-title":"Gastroepiploic vascularized lymph node transfer for extremities' lymphedema: is two better than one? A retrospective case-control study","volume":"75","author":"R Elia","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"04","key":"ref40","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1097\/SLA.0000000000005591","article-title":"A prospective study on the safety and efficacy of vascularized lymph node transplant","volume":"276","author":"S Brown","year":"2022","journal-title":"Ann Surg"},{"issue":"03","key":"ref41","doi-asserted-by":"crossref","first-page":"570","DOI":"10.3390\/jcm11030570","article-title":"The combination of lymph node transfer and excisional procedures in bilateral lower extremity lymphedema: clinical outcomes and quality of life assessment with long-term follow-up","volume":"11","author":"L Losco","year":"2022","journal-title":"J Clin Med"},{"issue":"05","key":"ref42","doi-asserted-by":"crossref","first-page":"e4314","DOI":"10.1097\/GOX.0000000000004314","article-title":"Liposuction and controlled compression therapy reduce the erysipelas incidence in primary and secondary lymphedema","volume":"10","author":"T Karlsson","year":"2022","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"03","key":"ref43","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.jvsv.2022.10.016","article-title":"Dermal-adipose lymphatic flap venous wrapping: a novel lymphaticovenous shunt method for progression of upper extremity lymphedema with severe lymphosclerosis","volume":"11","author":"T Yamamoto","year":"2023","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.bjps.2023.06.068","article-title":"Impact and outcomes after lymphaticovenous anastomosis for 150 cases of lymphoedema followed up over 24 months","volume":"85","author":"M Thomas","year":"2023","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"01","key":"ref45","doi-asserted-by":"crossref","first-page":"e70014","DOI":"10.1002\/micr.70014","article-title":"Effective management strategies for primary lymphedema of the lower extremities: integrating conservative and surgical therapies in early and late stages","volume":"45","author":"Y Farid","year":"2025","journal-title":"Microsurgery"},{"issue":"01","key":"ref46","doi-asserted-by":"crossref","first-page":"znad372","DOI":"10.1093\/bjs\/znad372","article-title":"Lymphatic venous anastomosis and complex decongestive therapy for lymphoedema: randomized clinical trial","volume":"111","author":"M Mihara","year":"2024","journal-title":"Br J Surg"},{"issue":"07","key":"ref47","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1056\/NEJMoa1917197","article-title":"Compression therapy to prevent recurrent cellulitis of the leg","volume":"383","author":"E Webb","year":"2020","journal-title":"N Engl J Med"},{"issue":"09","key":"ref48","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1055\/a-2508-6778","article-title":"Clinical variables associated with lymphedema surgery: physiologic versus excisional","volume":"41","author":"J Lenders","year":"2025","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref49","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1055\/s-0042-1755258","article-title":"Risk factors associated with adverse outcomes after ablative surgery for lymphedema","volume":"39","author":"A S Kuruvilla","year":"2023","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref50","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1055\/s-0044-1788345","article-title":"Identification of potential factors associated with cellulitis following lymphovenous bypass surgery in breast cancer survivors","volume":"41","author":"R A Torres-Guzman","year":"2025","journal-title":"J Reconstr Microsurg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2817-4764.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T23:31:24Z","timestamp":1772926284000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2817-4764"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,23]]},"references-count":48,"URL":"https:\/\/doi.org\/10.1055\/a-2817-4764","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2,23]]},"published":{"date-parts":[[2026,2,23]]}}}