{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T16:10:22Z","timestamp":1778170222715,"version":"3.51.4"},"reference-count":56,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>This study investigates long-term volume reduction after microsurgical autologous lymphatic vessel transplantation (LVT) in patients with chronic lymphoedema. Lymphoedema is caused by inadequate lymphatic drainage and leads to swelling, pain, and a reduced quality of life. Conservative treatments often show only limited success, which is why surgical procedures such as LVT are increasingly gaining in importance. In a retrospective long-term analysis, patients who underwent LVT between 1988 and 2010 were examined on average 21.7 years after surgery. The examination included pre- and post-operative volume measurements, which were supplemented by modern 3D body scanner analyses and lymphoscintigraphy. The results show a significant volume reduction both in the short term (p &lt; 0.01) and at the follow-up examination (p = 0.04). There was no significant difference between manual volumetry with circumferential measurements and 3D volumetry (p = 0.775). The improvement in lymph transport capacity was considerable (p = 0.078). This study provides valuable insights for the further development of lymphatic surgery. While preferred surgical methods change over time, this study demonstrates that LVT can make a decisive contribution to improving the quality of life of lymphedema patients.<\/jats:p>","DOI":"10.3390\/life15060914","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T10:10:16Z","timestamp":1749031816000},"page":"914","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Microsurgical Lymphatic Vessel Transplantation for Chronic Lymphedema: Long-Term Evaluation of Volume Reduction and Lymphatic Transport Kinetics"],"prefix":"10.3390","volume":"15","author":[{"given":"Wolfram","family":"Demmer","sequence":"first","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louisa Antonie","family":"Hock","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantin Christoph","family":"Koban","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul Severin","family":"Wiggenhauser","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Brendel","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Ludwig-Maximilians-University, 81377 Munich, Germany"},{"name":"German Center for Neurodegenerative Diseases (DZNE), 81377 Munich, Germany"},{"name":"Munich Cluster for Systems Neurology (SyNergy), 81377 Munich, Germany"},{"name":"Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Giunta","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim","family":"N\u00fcrnberger","sequence":"additional","affiliation":[{"name":"Department of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, 80539 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"key":"ref_1","unstructured":"Null, M., Arbor, T.C., and Agarwal, M. (2024). Anatomy, Lymphatic System. StatPearls, StatPearls Publishing."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.12968\/bjcn.2006.11.Sup2.20841","article-title":"Structure and function of the lymphatic system: An overview","volume":"11","author":"Ellis","year":"2006","journal-title":"Br. J. Community Nurs."},{"key":"ref_3","unstructured":"Ozdowski, L., and Gupta, V. (2024). Physiology, Lymphatic System. StatPearls, StatPearls Publishing."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e171582","DOI":"10.1172\/JCI171582","article-title":"The emerging importance of lymphatics in health and disease: An NIH workshop report","volume":"133","author":"Mehrara","year":"2023","journal-title":"J. Clin. Investig."},{"key":"ref_5","unstructured":"Casley-Smith, J.R., and F\u00f6ldi, M. (1987). Lymphangiology, Schattauer Verlag."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1089\/wound.2021.0041","article-title":"Current Understanding of Pathological Mechanisms of Lymphedema","volume":"11","author":"Sung","year":"2022","journal-title":"Adv. Wound Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1055\/s-0043-108273","article-title":"Management of Lymphedema","volume":"142","author":"Baumeister","year":"2017","journal-title":"Dtsch. Med. Wochenschr."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Brix, B., Sery, O., Onorato, A., Ure, C., Roessler, A., and Goswami, N. (2021). Biology of Lymphedema. Biology, 10.","DOI":"10.3390\/biology10040261"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s00508-020-01766-y","article-title":"Diagnosis, prevention and therapy of lymphedema","volume":"133","author":"Flores","year":"2021","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_10","unstructured":"Sleigh, B.C., and Manna, B. (2024). Lymphedema. StatPearls, StatPearls Publishing."},{"key":"ref_11","first-page":"121","article-title":"The effects of reduction operation with genital lymphedema on the frequency of erysipelas and the quality of life","volume":"44","author":"Zvonik","year":"2011","journal-title":"Lymphology"},{"key":"ref_12","first-page":"740","article-title":"Zur Diagnostik und Therapie des Lymph\u00f6dems","volume":"95","author":"Baumeister","year":"1998","journal-title":"Dtsch. Arztebl. International"},{"key":"ref_13","unstructured":"F\u00f6ldi, E., F\u00f6ldi, M., and Kubik, S. (2010). F\u00f6ldi\u2019s Textbook of Lymphology, Urban & Fischer Verlag\/Elsevier GmbH."},{"key":"ref_14","first-page":"193","article-title":"Quality-of-life and body image impairments in patients with lymphedema","volume":"39","author":"Roth","year":"2006","journal-title":"Lymphology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1093\/qjmed\/hcg126","article-title":"Lymphoedema: An underestimated health problem","volume":"96","author":"Moffatt","year":"2003","journal-title":"QJM"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1089\/lrb.2018.0084","article-title":"LIMPRINT: Health-Related Quality of Life in Adult Patients with Chronic Edema","volume":"17","author":"Mercier","year":"2019","journal-title":"Lymphat. Res. Biol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1089\/lrb.2009.0004","article-title":"The psycho-social impact of lymphedema","volume":"7","author":"Ridner","year":"2009","journal-title":"Lymphat. Res. Biol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s40249-015-0068-7","article-title":"The burden of mental health in lymphatic filariasis","volume":"4","author":"Ton","year":"2015","journal-title":"Infect. Dis. Poverty"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.jvsv.2019.02.015","article-title":"Lymphedema-associated comorbidities and treatment gap","volume":"7","author":"Son","year":"2019","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.soc.2017.08.001","article-title":"Surgical Intervention for Lymphedema","volume":"27","author":"Gallagher","year":"2018","journal-title":"Surg. Oncol. Clin. N. Am."},{"key":"ref_21","first-page":"1","article-title":"Bonn Vein Study by the German Society of Phlebology","volume":"32","author":"Rabe","year":"2003","journal-title":"Phlebologie"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s12282-022-01428-z","article-title":"What do we know about treating breast-cancer-related lymphedema? Review of the current knowledge about therapeutic options","volume":"30","author":"Anuszkiewicz","year":"2023","journal-title":"Breast Cancer"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Baumeister, R.G.H. (2016). Reconstructive Lymph Vascular Surgery, Springer International Publishing.","DOI":"10.1007\/978-3-319-31647-5"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Garza, R., Skoracki, R., Hock, K., and Povoski, S.P. (2017). A comprehensive overview on the surgical management of secondary lymphedema of the upper and lower extremities related to prior oncologic therapies. BMC Cancer, 17.","DOI":"10.1186\/s12885-017-3444-9"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1097\/PRS.0000000000005993","article-title":"Surgical Treatment of Lymphedema","volume":"144","author":"Schaverien","year":"2019","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1007\/s12032-024-02576-2","article-title":"Advances in surgical management of chronic lymphedema: Current strategies and future directions","volume":"42","author":"Sanka","year":"2025","journal-title":"Med. Oncol."},{"key":"ref_27","first-page":"202","article-title":"The microsurgical lymph vessel transplantation","volume":"35","author":"Baumeister","year":"2003","journal-title":"Handchir. Mikrochir. Plast. Chir."},{"key":"ref_28","first-page":"34","article-title":"Microsurgical Lymphatic Vessel Transplantation","volume":"32","author":"Baumeister","year":"2016","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1002\/micr.20968","article-title":"Treatment of various secondary lymphedemas by microsurgical lymph vessel transplantation","volume":"32","author":"Felmerer","year":"2012","journal-title":"Microsurgery"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/S0140-6736(81)90723-6","article-title":"Autotransplantation of lymphatic vessels","volume":"1","author":"Baumeister","year":"1981","journal-title":"Lancet"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Heberer, G., Feifel, K., and Me\u00dfmer, G. (1980). Transplantation of lymph vessels on rats as well as a first therapeutic application on the experimental lymphedema of the dog. Proceedings of the 97th Congress of the German Society of Surgery, Munich, Germany, 14\u201319 May 1980, FRG.","DOI":"10.1159\/isbn.978-3-8055-8816-4"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1055\/s-0043-123937","article-title":"Role of Indocyanine Green in Fluorescence Imaging with Near-Infrared Light to Identify Sentinel Lymph Nodes, Lymphatic Vessels and Pathways Prior to Surgery\u2014A Critical Evaluation of Options","volume":"78","author":"Hackethal","year":"2018","journal-title":"Geburtshilfe Frauenheilkd."},{"key":"ref_33","first-page":"65","article-title":"Changes in quality of life of patients with lymphedema after lymphatic vessel transplantation","volume":"44","author":"Springer","year":"2011","journal-title":"Lymphology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/00006534-199001000-00012","article-title":"Treatment of lymphedemas by microsurgical lymphatic grafting: What is proved?","volume":"85","author":"Baumeister","year":"1990","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Hock, L.A., Nurnberger, T., Koban, K.C., Wiggenhauser, P.S., Giunta, R., and Demmer, W. (2024). Quality of Life in Lymphedema Patients Treated by Microsurgical Lymphatic Vessel Transplantation-A Long-Term Follow-Up. Life, 14.","DOI":"10.3390\/life14080957"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Farina, G., Galli, M., Borsari, L., Aliverti, A., Paraskevopoulos, I.T., and LoMauro, A. (2024). Limb Volume Measurements: A Comparison of Circumferential Techniques and Optoelectronic Systems against Water Displacement. Bioengineering, 11.","DOI":"10.3390\/bioengineering11040382"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1007\/s00520-018-4334-7","article-title":"Lymphedema symptoms and limb measurement changes in breast cancer survivors treated with neoadjuvant chemotherapy and axillary dissection: Results of American College of Surgeons Oncology Group (ACOSOG) Z1071 (Alliance) substudy","volume":"27","author":"Armer","year":"2019","journal-title":"Support. Care Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"De Stefani, A., Barone, M., Hatami Alamdari, S., Barjami, A., Baciliero, U., Apolloni, F., Gracco, A., and Bruno, G. (2022). Validation of Vectra 3D Imaging Systems: A Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19148820"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.bjps.2015.10.011","article-title":"3D stereophotogrammetry in upper-extremity lymphedema: An accurate diagnostic method","volume":"69","author":"Hameeteman","year":"2016","journal-title":"J. Plast. Reconstr. Aesthetic Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1089\/lrb.2014.0007","article-title":"Validity and reliability of three-dimensional imaging for measuring the volume of the arm","volume":"12","author":"Erends","year":"2014","journal-title":"Lymphat. Res. Biol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e1396","DOI":"10.1097\/GOX.0000000000001396","article-title":"Diagnostic Accuracy of Lymphoscintigraphy for Lymphedema and Analysis of False-Negative Tests","volume":"5","author":"Hassanein","year":"2017","journal-title":"Plast. Reconstr. Surg. Glob. Open"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1148\/radiology.167.3.3363131","article-title":"Lymphedema: Evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients","volume":"167","author":"Weissleder","year":"1988","journal-title":"Radiology"},{"key":"ref_43","first-page":"236","article-title":"Lymphoscintigraphy for non-invasive long term follow-up of functional outcome in patients with autologous lymph vessel transplantation","volume":"35","author":"Weiss","year":"1996","journal-title":"Nuklearmedizin"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e117","DOI":"10.1097\/RLU.0000000000000579","article-title":"Lymphedema of the upper limb: Evaluation of the functional outcome by dynamic imaging of lymph kinetics after autologous lymph vessel transplantation","volume":"40","author":"Weiss","year":"2015","journal-title":"Clin. Nucl. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1002\/jso.25526","article-title":"Lymphoscintigraphy for the diagnosis of extremity lymphedema: Current controversies regarding protocol, interpretation, and clinical application","volume":"121","author":"Pappalardo","year":"2020","journal-title":"J. Surg. Oncol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/BF00251310","article-title":"Evaluation of transport kinetics in lymphoscintigraphy: Follow-up study in patients with transplanted lymphatic vessels","volume":"10","author":"Kleinhans","year":"1985","journal-title":"Eur. J. Nucl. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1007\/s11764-020-00928-1","article-title":"Manual lymphatic drainage treatment for lymphedema: A systematic review of the literature","volume":"15","author":"Thompson","year":"2021","journal-title":"J. Cancer Surviv."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"83","DOI":"10.12968\/bjcn.2024.29.2.83","article-title":"Manual lymphatic drainage: The evidence behind the efficacy","volume":"29","author":"Ramadan","year":"2024","journal-title":"Br. J. Community Nurs."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1111\/acel.12330","article-title":"Aging-related anatomical and biochemical changes in lymphatic collectors impair lymph transport, fluid homeostasis, and pathogen clearance","volume":"14","author":"Zolla","year":"2015","journal-title":"Aging Cell"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1007\/s00259-002-1020-1","article-title":"Dynamic lymph flow imaging in patients with oedema of the lower limb for evaluation of the functional outcome after autologous lymph vessel transplantation: An 8-year follow-up study","volume":"30","author":"Weiss","year":"2003","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1097\/00003072-200211000-00007","article-title":"Post-therapeutic lymphedema: Scintigraphy before and after autologous lymph vessel transplantation: 8 years of long-term follow-up","volume":"27","author":"Weiss","year":"2002","journal-title":"Clin. Nucl. Med."},{"key":"ref_52","first-page":"182","article-title":"Diagnosis of leg edema","volume":"74","author":"Stucker","year":"2023","journal-title":"Dermatologie"},{"key":"ref_53","first-page":"393","article-title":"Quantitative volumetric analysis of the lower extremity: Validation against established tape measurement and water displacement","volume":"50","author":"Koban","year":"2018","journal-title":"Handchir. Mikrochir. Plast. Chir."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.avsg.2024.01.011","article-title":"Digital Volumetric Measurements Based on 3D Scans of the Lower Limb: A Valid and Reproducible Method for Evaluation in Lymphedema Therapy","volume":"105","author":"Schiltz","year":"2024","journal-title":"Ann. Vasc. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1007\/s10278-021-00493-8","article-title":"Digital Leg Volume Quantification: Precision Assessment of a Novel Workflow Based on Single Capture Three-dimensional Whole-Body Surface Imaging","volume":"34","author":"Etzel","year":"2021","journal-title":"J. Digit. Imaging"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1016\/j.bjps.2017.07.016","article-title":"Accuracy and reproducibility of a newly developed tool for volume measurements of the arm using 3D stereophotogrammetry","volume":"70","author":"Verhulst","year":"2017","journal-title":"J. Plast. Reconstr. 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