The correlation between oxidative stress and increased lymphedematous limb volume lacks supporting evidence. Lymphedema patients are prone to cellulitis. This study aims to investigate the link between oxidative stress, limb volume, and cellulitis after supermicrosurgical lymphaticovenous anastomosis (LVA).

In this study, we focused on the changes in serum antioxidant biomarkers before and after LVA, detected by isobaric tags for relative and absolute quantitation (iTRAQ)-based quantitative proteomic analysis, enzyme-linked immunosorbent assay (ELISA), and Oxidative Stress Panel Kit. For clinical correlation, magnetic resonance (MR) volumetry was implemented for precise lymphedematous limb volume measurements. Correlations were made between changes in oxidative stress, limb volume, and cellulitis before and after LVA.

Inclusion Criteria:

• patients with lower limb lymphedema confirmed with lymphoscintigraphy
• unilateral lower limb lymphedema
• lymphedema duration > 2 years
• no active infection
• no prophylactic antibiotic use for at least one month before LVA
• no tumor recurrence or metastasis
• no consumption of antioxidants, such as vitamin E or ascorbic acid

Exclusion Criteria:

• Patients with upper limb and bilateral lower limb lymphedema

Written informed consent was obtained from all patients. Between June 2018 and May 2019, 26 patients with lower limb lymphedema confirmed with lymphoscintigraphy were recruited. Patients with upper limb and bilateral lower limb lymphedema were excluded.