Combined Treatment with Lymphaticovenular Anastomosis and Ethanol Sclerotherapy for Cystic Lymphangioma in a Limb.

Several treatment options, including sclerotherapy and surgical excision, are available for the management of cystic lymphangioma. Lymphaticovenular anastomosis (LVA) has recently garnered attention in the field of microsurgery as a minimally invasive surgical reconstruction strategy. Combined treatment using surgical excision and LVA for large or persistent cystic lymphatic malformations has been reported but can be very invasive. This case report describes use of a combination of LVA and sclerotherapy to treat cystic lymphatic malformations with satisfactory results. This combination could be a complementary minimally invasive treatment for extensive cystic lymphatic malformations. The patient was an 18-year-old woman with a cystic lymphangioma from the axilla to the subclavicular area beneath pectoralis major and pectoralis minor. The size was a diameter of 12 cm and a maximum depth of 8 cm. The cystic lymphangioma was managed by combined treatment of LVA and ethanol sclerotherapy. The patient had subsequent resolution of the lymphangioma without any symptoms of lymphedema or recurrence. LVA is thought to be a less invasive treatment option when the lymphatics flowing into a cyst are detectable or can be targeted. However, this is not always the case, especially if the cyst is large, persistent, or infected. Combination of LVA with sclerotherapy is a relatively less invasive method with closure of the dead space using sclerotherapy without further exacerbation or occurrence of lymphedema. Therefore, combined treatment using LVA with sclerotherapy can be a complementary minimally invasive treatment option for a large or persistent lymphocele.