Abstract
The management of lymphatic malformations (LMs) is challenging, particularly for large and complex lesions involving anatomical structures in the adjacent tissue. While lymphovenous anastomosis (LVA) has been reported as an effective treatment for lymphedema, it has hardly been described as a treatment for LM. Virtual reality has the ability to visualize human structures in three dimensions and can be used for the preoperative planning of complex cases. Here, we describe the first case of the management of an LM by LVA preoperatively planned with virtual reality. A young woman presented with an LM previously treated by gross excision. Following persistent complaints of swelling, a minimally invasive microsurgical intervention was planned. The results of the single photon emission tomography with computed tomography (SPECT-CT) and lymphoscintigraphy were analyzed using a virtual reality program, and a 3D patient-specific model was constructed. Based on the combined findings of this 3D model and lymphography with a fluorescent marker, a precise skin incision could be determined and one lymph vessel was anastomosed to a nearby vein. The swelling of the thigh reduced and the discomfort disappeared. Although more reports are needed to confirm its efficacy, LVA planned with virtual reality constructed images appears to be a valuable treatment option for complex lesions, including LMs.
Highlights
Lymphatic malformations, known as lymphangiomas, are a complex group of congenital vascular anomalies that do not undergo involution and can cause pain, swelling, and functionalJ
This report describes the first case of lymphovenous anastomosis planned using virtual reality and successfully applied to a patient with a lymphatic malformation
Lymphovenous anastomosis as a treatment for lymphatic malformations has rarely been described in literature
Summary
Known as lymphangiomas, are a complex group of congenital vascular anomalies that do not undergo involution and can cause pain, swelling, and functional. CCoonnsseerrvvaattiivveettrreeaattmmeennttbbyymmeeaannssooff mmaannuuaall llyymmpphh ddrraaiinnaaggee aanndd ccoommpprreessssiioonn ggaarrmmeennttss wwaass iinniittiiaatteedd;; hhoowweevveer,r,resreusltusltws erweeurnesautinssfaactitsofrayc.tGoriyv.enGtihveernefrtahcetorreyfrsawcetollrinyg sawndelclionngtinaunedd ccoomntpinlauinedts coofmapfleaeinlitnsgoof fapfreeeslisnugreofatptrhesesluerveeal totfhtehleevgerol ionf,tahnedgrgoiivne,nanthdegaipvepnliethdegarpopsslieedxcgisrioosns ienxctihseiopnaisnt, tahempinaismt, aallmy iinnivmaasilvlye isnuvragsiicvael isnutregrviceanltiinotnerwveans tpiolannwneads.planned. FFiinnaallllyy,, tthhee iimmaaggeess ffrroomm tthhee SSPPEECCTT--CCTT aanndd llyymmpphhoosscciinnttiiggrraapphhyywweerree aannaallyyzzeeddwwiitthhaa vviirrttuuaall rreeaalliittyy pprrooggrraamm ((MMeeddiiccaallhhoollooddeecckk, ,ZZuurriicchh, ,SSwwiittzzeerrlalanndd))[[1122]]tthhaattaalllloowweeddtthhee vviissuuaalliizzaattiioonniinnaa 33DD mmooddeell oofftthheellooccaalliizzaattiioonnoofftthheellyymmpphhaattiiccmmaallffoorrmmaattiioonn((FFiigguurree33aa,,VViiddeeoo SS11)),, wwiitthh iittss eexxtteennssiioonn iinnttoo tthheeaabbddoommiinnaallccaavviittyy,, iinn aa vviirrttuuaall rreeaalliittyy eennvviirroonnmmeenntt ((FFiigguurree 33bb,, VViiddeeooSS22)). A 3 cm skin incision (higher panel) prior to the lymphovenous anastomosis (black arrow, lower panel). In volume between the left and right leg was reduced to 224 mL (Perometer 400 NT) [10] (Figure 1c). The result was very good, with further reduction of the volume of the right leg; the difference in volume between the left and right leg was reduced to 224 mL (Perometer 400 NT) [10] (Figure 1c)
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