This page introduces a peer-reviewed study published in the British Journal of Surgery (2014), authored by the director of Lymphedema Clinic Tokyo, examining whether lymphaticovenular anastomosis (LVA) may help reduce recurrent cellulitis in patients with lymphedema.

Designed for international patients, the page explains the study findings in a clear, patient-friendly manner and outlines how evidence-based lymphedema care, combining conservative treatment and LVA, is practiced at our specialized clinic in Tokyo.

【Evidence-Based Care at Lymphedema Clinic Tokyo】

At Lymphedema Clinic Tokyo, we specialize in the comprehensive management of lymphedema, combining conservative therapy with lymphaticovenular anastomosis (LVA) according to each patient’s individual condition.

 

Our clinical approach is grounded in peer-reviewed scientific evidence, including research conducted and published by our own medical team.

One of the most distressing complications of lymphedema is recurrent cellulitis, often accompanied by high fever, severe pain, and repeated hospital admissions. Reducing the frequency of these infections is a key goal of lymphedema care.

 

【About This Study (BJS 2014)】

The study introduced on this page was authored by Dr. Makoto Mihara, Director of Lymphedema Clinic Tokyo, and published in the British Journal of Surgery, one of the most respected international journals in surgery.

This research was conducted as an international collaborative study involving medical teams in:

・Japan (Our team)

・Italy (University of Rome and University of Siena)

・United Kingdom (University of Oxford)

The aim of the study was to evaluate whether lymphaticovenular anastomosis (LVA) could reduce the frequency of cellulitis in patients with lymphedema.

 

【Study Design】

Participants: Patients with upper- or lower-limb lymphedema

 

Method:

The frequency of cellulitis episodes was compared one year before and one year after LVA surgery

Outcome measured:

Annual number of cellulitis episodes

 

【Key Findings】

The study demonstrated a marked reduction in cellulitis frequency after LVA:

・Before surgery: Mean of 1.46 episodes per year

・After surgery: Mean of 0.18 episodes per year

 

This result suggests that a single LVA procedure may reduce the frequency of cellulitis to approximately one-eighth of the preoperative level in selected patients.

Importantly, this study did not claim a cure for lymphedema, but showed that cellulitis frequency may be significantly reduced as part of an evidence-based treatment strategy.

 

【Why LVA May Help Prevent Cellulitis】

In lymphedema, impaired lymphatic drainage leads to reduced local immune defense.

Once cellulitis occurs, inflammation can further damage lymphatic vessels, increasing the risk of recurrence.

LVA creates new drainage pathways from lymphatic vessels to nearby veins, which may:

Reduce lymph stagnation

Improve local tissue conditions

Interrupt the cycle of recurrent infection

 

【Our Perspective at Lymphedema Clinic Tokyo】

“We believe that recurrent cellulitis should not be regarded as something patients must simply endure.

This study helped clarify that, in appropriately selected patients, LVA can be an important option to reduce the burden of repeated infections.”

At our clinic, we do not recommend surgery alone.

We carefully combine:

・Conservative therapy (compression, skin care, exercise guidance)

・Day-surgery LVA

to create a personalized, step-by-step treatment plan for each patient.

 

【Original Research Article (Open Access)】

Patients and clinicians are encouraged to read the original paper:

Mihara M, et al.

 

Lymphaticovenular anastomosis to prevent cellulitis associated with lymphoedema

British Journal of Surgery, 2014

🔗 https://doi.org/10.1002/bjs.9588

 

【More Research Recommended by Our Clinic】

A curated list of lymphedema-related research articles recommended by our team is available at the bottom of the following page:

🔗 https://www.english-mominoki-shinryosho.net/research/

 

This page is intended for educational purposes only and does not guarantee individual treatment outcomes.

All treatment decisions are made after personalized medical evaluation.

【Frequently Asked Questions (FAQ)】

Recurrent Cellulitis and Lymphaticovenular Anastomosis (LVA)

Based on a BJS 2014 Study Authored by Our Team

 

 

Q1. What is cellulitis, and why is it a major problem for patients with lymphedema?

A.

Cellulitis is a serious bacterial skin infection that often occurs in patients with lymphedema.

Because lymphatic drainage is impaired, the local immune defense in the affected limb is weakened.

As a result, cellulitis may:

・Develop suddenly

・Be accompanied by high fever and severe pain

・Require hospitalization

・Recur repeatedly, significantly limiting daily life

 

 

Q2. What was the purpose of the BJS 2014 study?

A.

The purpose of this study was to evaluate whether lymphaticovenular anastomosis (LVA) could reduce the frequency of recurrent cellulitis in patients with lymphedema.

The study was authored by Dr. Makoto Mihara, Director of Lymphedema Clinic Tokyo, and published in the British Journal of Surgery.

 

 

Q3. Was this an international study?

A.

Yes.

This research was conducted as an international collaborative study involving medical teams from:

Japan

Italy (University of Rome and University of Siena)

United Kingdom (University of Oxford)

This international collaboration strengthens the clinical relevance of the findings.

 

 

Q4. How was the study conducted?

A.

Patients with upper- or lower-limb lymphedema who underwent LVA were evaluated.

The researchers compared:

The number of cellulitis episodes one year before surgery

The number of cellulitis episodes one year after surgery

The main outcome was the annual frequency of cellulitis.

 

 

Q5. What were the key results of the study?

A.

The study showed a marked reduction in cellulitis frequency after LVA:

Before LVA: Average of 1.46 episodes per year

After LVA: Average of 0.18 episodes per year

This suggests that, in selected patients, a single LVA procedure may reduce cellulitis frequency to approximately one-eighth of the preoperative level.

 

 

Q6. Does this mean LVA cures lymphedema?

A.

No.

The study does not claim that LVA cures lymphedema.

Instead, it suggests that LVA may help reduce the frequency of recurrent cellulitis, which is one of the most debilitating complications of lymphedema.

 

 

Q7. Why might LVA help reduce cellulitis?

A.

In lymphedema, stagnant lymph fluid impairs local immune function.

LVA creates new drainage pathways from lymphatic vessels to nearby veins, which may:

Reduce lymph stagnation

Improve tissue conditions

Interrupt the cycle of recurrent infection

This is the proposed mechanism by which LVA may reduce cellulitis risk.

 

 

Q8. Is LVA appropriate for all patients with lymphedema?

A.

No.

LVA is not suitable for every patient.

We carefully evaluate:

The condition of lymphatic vessels

Imaging findings

Response to conservative therapy

Overall health status

Only patients who are appropriate candidates are advised to consider LVA.

 

 

Q9. Is conservative therapy still necessary after LVA?

A.

Yes.

Conservative therapy—such as compression garments, skin care, and exercise—remains the foundation of lymphedema management.

At our clinic, we combine conservative therapy and LVA, rather than viewing them as alternatives.

 

 

Q10. How does this study influence care at Lymphedema Clinic Tokyo?

A.

Because this study was authored by our director, its findings directly inform our clinical approach.

We believe that recurrent cellulitis should not be regarded as something patients must simply endure.

Instead, we use evidence from this study to help guide individualized treatment strategies for selected patients.

 

 

Q11. Can international patients realistically undergo treatment in Japan?

A.

Yes, in many cases.

We support international patients by:

Providing detailed pre-visit consultations

Coordinating evaluations efficiently

Offering clear postoperative guidance after returning home

Many patients successfully combine treatment in Japan with follow-up care in their home country.

 

 

Q12. Can patients read the original research paper themselves?

A.

Yes. The original article is publicly available:

Mihara M, et al.

Lymphaticovenular anastomosis to prevent cellulitis associated with lymphoedema

British Journal of Surgery, 2014

🔗 https://doi.org/10.1002/bjs.9588

 

 

Q13. Where can I find more research recommended by your clinic?

A.

A curated list of lymphedema-related research articles recommended by our team is available at the bottom of the following page:

🔗 https://www.english-mominoki-shinryosho.net/research/

 

【A Final Message】

If you are living with recurrent cellulitis and feel that your life has been placed on hold,

please know that you are not alone.

While outcomes vary among individuals, careful evaluation and evidence-based care may offer meaningful improvement in selected patients.