Advanced Primary Lymphedema Treated With Duo-Plane Lymphovenous Bypass.

Advanced primary lymphedema is challenging to treat and imposes physical and psychosociological burdens on patients. Currently, vascularized lymph node transfer and modified Charles procedures are recommended for late-stage patients due to the limited functional superficial lymphatics required for conventional lymphovenous bypass. However, the reconstruction involves radical resection of tissue and changes in lymphatic flow, resulting in prolonged recovery time, high complication rates, and emotional and economic burdens on the patients. The authors proposed a novel alternative for treating stage II primary lymphedema using a duo-plane lymphovenous bypass. The innovation involves anastomosing the collecting lymphatics in the deeper subcutaneous tissue to superficial venules. The technique benefits from accessing functional lymphatics with preserved architecture, a larger vessel diameter, and a well-defined anatomical location to optimize drainage and prevent venous backflow using the Venturi effect. The duo-plane lymphovenous bypass procedure warrants significant volume reduction, faster recovery, and minimal scarring, thus providing a less-invasive treatment option for patients with advanced primary lymphedema.