Lymphedema surgery: the current state of the art
Lymphedema surgery, when integrated into a comprehensive lymphedema treatment program for patients, can provide effective and long-term improvements that non-surgical management alone cannot achieve. Such a treatment program can provide significant improvement for many issues such as recurring cellulitis infections, inability to wear clothing appropriate for the rest of their body size, loss of function of arm or leg, and desire to decrease the amount of lymphedema therapy and compression garment use.
The fluid predominant portion of lymphedema may be treated effectively with surgeries that involve transplantation of lymphatic tissue, called vascularized lymph node transfer (VLNT), or involve direct connections from the lymphatic system to the veins, called lymphaticovenous anastomoses (LVA). VLNT and LVA are microsurgical procedures that can improve the patient’s own physiologic drainage of the lymphatic fluid, and we have seen the complete elimination for the need of compression garments in some of our patients. These procedures tend to have better results when performed when a patient’s lymphatic system has less damage. The stiff, solid-predominant swelling often found in later stages of lymphedema can be treated effectively with a surgery called suction-assisted protein lipectomy (SAPL). SAPL surgeries allow removal of lymphatic solids and fatty deposits that are otherwise poorly treated by conservative lymphedema therapy, VLNT or LVA surgeries.
Overall, multiple effective surgical options for lymphedema exist. Surgical treatments should not be seen as a “quick fix”, and should be pursued in the framework of continuing lymphedema therapy and treatment to optimize each patient’s outcome. When performed by an experienced lymphedema surgeon as part of an integrated system with expert lymphedema therapy, safe, consistent and long-term improvements can be achieved.
KeywordsLymphedema surgery VLNT LVA SAPL Lymph node transfer
- 20.Yamada Y (1969) The studies on lymphatic venous anastomosis. Nagoya J Med Sci 32:1–21Google Scholar
- 26.Boccardo F, De Cian F, Campisi CC, Molinari L, Spinaci S, Dessalvi S, Talamo G, Campisi C, Villa G, Bellini C, Parodi A, Santi PL, Campisi C (2013) Surgical prevention and treatment of lymphedema after lymph node dissection in patients with cutaneous melanoma. Lymphology 46(1):20–26PubMedGoogle Scholar
- 33.Boyages J, Kastanias K, Koelmeyer LA, Winch CJ, Lam TC, Sherman KA, Munnoch DA, Brorson H, Ngo QD, Heydon-White A, Magnussen JS, Mackie H (2015) Liposuction for advanced lymphedema: a multidisciplinary approach for complete reduction of arm and leg swelling. Ann Surg Oncol 22:1263–1270CrossRefGoogle Scholar
- 34.Brorson H, Freccero C, Ohlin K, Svensson B, Åberg M, Svensson H (2012) Seventeen years’ experience of complete reduction of arm lymphedema following breast cancer. Progress in lymphology XXIII. Proceedings of the 23rd International Congress of Lymphology; Sept 19–23, 2011, Malmö, Sweden. Lymphology 45:279–281Google Scholar
- 35.Brorson H. Ohlin K. Olsson G, Svensson B (2207) Liposuction normalized elephantiasis of the leg: a prospective study. Eur J Lymphol 17:8Google Scholar
- 37.Damstra RJ, Voesten HGJ, van Schleven WD, van der Lei B (2009) Lymphatic venous anastomosis (LVA) for treatment of secondary arm lymphedema. A prospective study of 11 LVA procedures in 10 patients with breast cancer related lymphedema and a critical review of the literature. Breast Cancer Res Treat 113:199–206CrossRefPubMedGoogle Scholar
- 40.Hadamitzky C, Zaitseva T, Bazalova M, Paukshto M, Hou L, Strassberg Z, Ferguson J, Matsuura Y, Dash R, Yang P, Kretchetov S, Vogt P, Rockson S, Cooke J, Huang N (2015) Lymphangiogenesis guided by aligned nanofibrillar collagen scaffolds for treatment of secondary lymphoedema. World Congress of Lymphology, San FranciscoGoogle Scholar