The Recipient Venule in LVA

Recipient venule has an independent impact on the surgical outcome of LVA, despite the lymphatic degeneration status. The venule dynamic at the anastomosis can be classified using backflow, slack, outlet, hydropower (BSOH) system. Different scenarios are possible, and the supermicrosurgeon should always be prepared to find a solution to establish the best lymphaticovenous anastomosis (LVA) possible. In this chapter, the author proposes an algorithm that may aid the lymphatic microsurgeon in the selection of recipient venule and the consequent anastomosis configuration in order to obtain the best flow dynamics through the LVA. Ultrasound is the quintessence in lymphatic surgery preoperative planning as it allows us to know preoperatively what it will be found in that incision and thus eventually preoperatively already prepare for alternative surgical strategies.