Yamamoto, T., Yamamoto, N., Yamashita, M., Furuya, M., Hayashi, A., & Koshima, I. (2014). Efferent lymphatic vessel anastomosis: Supermicrosurgical efferent lymphatic vessel-to-venous anastomosis for the prophylactic treatment of subclinical lymphedema. Annals of Plastic Surgery. Advance online publication. 

To determine the effectiveness of efferent lymphatic vessel anastomosis on subclinical lower extremity lymphedema and on the prevention of lower extremity lymphedema in patients with gynecologic cancer

Fourteen patients with unilateral lower extremity subclinical lymphedema received the intervention of supermicrosurgical efferent lymphatic vesssel-to-vessel anastomosis under local anesthesia. Leg dermal backflow (LDB) was used to determine preoperative and postoperative lymphedema volume. Patients were re-evaluated at a one-year interval.

• N = 14  
• AGE RANGE = 34–79 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All gynecologic cancers including ovarian, uterine, and cervical
• OTHER KEY SAMPLE CHARACTERISTICS: No inguinal lymph node dissection; five had a history of pelvic radiation; six had a history of cellulitis 

• SITE: Not stated
• SETTING TYPE: Outpatient    
• LOCATION: Toranomon Hospital and University of Tokyo in Japan

• PHASE OF CARE: Late effects and survivorship

Pre- and post-test design

• Lower Extremity Lymphedema (LEL) Index 
• Leg Dermal Backflow (LDB) Staging
• Student paired T test and two tests for statistic analyses

All 14 of the surgeries were without perioperative issues. Tension sensation in patients was decreased (significant finding), and a downstaging of LDB stage also was significant.

This study was an important start for investigating improved surgical techniques to reduce and prevent the burden of lower extremity lymphedema. However, the sample size was too small, and other possible variables (such as history of certain chemotherapies or current treatments) were not discussed. It also was unclear how the participants were chosen or if they were randomized properly.

• Small sample (< 30)
• Risk of bias (no random assignment) 
• Other limitations/explanation: Unclear whether patients continued to receive chemotherapy; body surface area unknown

For nurses, having knowledge of these interventions is important to understanding how to educate patients on current and future options. Being up to date on current interventions and knowing if one's facility is current is important to each nurse's individual practice and professional growth. However, this is not an intervention that nurses can directly affect at this point.