Surgical Treatments for Lymphedema



In the past, surgical excision is the only treatment, if there are secondary changes, without pathophysiological correction. But contemporary therapeutic concept is focused on pathophysiological correction and effective when performed before secondary histological changes. An obstructive factor is that lymphatics is very thin. Thus, development of microsurgery is crucial. Also because various conservative therapeutic options, such as extremity elevation, compressive therapy, complex decongestive therapy, and compressive pump therapy, outweighed the surgery, physicians take account for what surgery to do and when to do.


  1. 1.
    Handley WS. Elephantiasis treated by Lymphangioplasty. Proc R Soc Med. 1909;2(Clin Sect):123–5.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer. Scand J Plast Reconstr Surg Hand Surg. 1997;31(2):137–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Baumeister RGH. Lymphedema: Surgical Treatment. In: Cronenwett JL, Johnston KW, editors. Rutherford's Vascular Surgery. Philadelphia: Elsevier; 2014. p. 1028–42.Google Scholar
  4. 4.
    Teng E, Chang DW. Overview of Surgical Techniques. In: Cheng M-H, Chang DW, Patel KM, editors. Principles and Practice of Lymphedema Surgery. Philadelphia: Elsevier; 2016. p. 87–97.Google Scholar
  5. 5.
    Hadamitzky C et al. Surgical procedures in lymphedema management. J Vasc Surg: Venous and Lym Dis. 2014;2(4):461–8.Google Scholar
  6. 6.
    Homans J, Drinker CK, Field M. Elephantiasis and the Clinical Implications of Its Experimental Reproduction in Animals. Ann Surg. 1934;100(4):812–32.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Miller TA, Harper J, Longmire Jr WP. The management of lymphedema by staged subcutaneous excision. Surg Gynecol Obstet. 1973;136(4):586–92.PubMedGoogle Scholar
  8. 8.
    Illouz Y-G, Villers YTD. Body Sculpturing by Lipoplasty. New York: Churchill Livingstone; 1989.Google Scholar
  9. 9.
    Gillies H, Fraser FR. Treatment of Lymphoedema by Plastic Operation: (a Preliminary Report). Br Med J. 1935;1(3863):96–8.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Baumeister, R.G. and S. Siuda, Treatment of lymphedemas by microsurgical lymphatic grafting: what is proved? Plast Reconstr Surg, 1990. 85(1): p. 64–74; discussion 75–6.Google Scholar
  11. 11.
    Yamashita S, Chang DW, Koshima I. Microsurgical procedures: Lymphovenous anastomosis techniques. In: Cheng M-H, Chang DW, Patel KM, editors. Principles and practice of lymphedema surgery. Edinburgh: Elsevier; 2016. p. 173–9.Google Scholar
  12. 12.
    Shim YK. Experience of lymphedema treated by using free vascularized normal lymph node transfer in 14 cases. International Angiology. 2015;34(Suppl 1):30.Google Scholar
  13. 13.
    Maldonado GE et al. Autologous stem cells for the treatment of post-mastectomy lymphedema: a pilot study. Cytotherapy. 2011;13(10):1249–55.CrossRefPubMedGoogle Scholar
  14. 14.
    Shim YK. Therapeutic trial of lymphedema using adipocyte derived stem cell grafts with combined therapy. International Angiology. 2015;34(Suppl 1):109.Google Scholar
  15. 15.
    Gloviczki P. Principles of surgical treatment of chronic lymphoedema. Int Angiol. 1999;18(1):42–6.PubMedGoogle Scholar
  16. 16.
    Miller TA. A surgical approach to lymphedema. Am J Surg. 1977;134(2):191–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Kim DI et al. Excision of subcutaneous tissue and deep muscle fascia for advanced lymphedema. Lymphology. 1998;31(4):190–4.PubMedGoogle Scholar
  18. 18.
    Kim DI et al. Excisional surgery for chronic advanced lymphedema. Surg Today. 2004;34(2):134–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Lee BB et al. Current concepts in lymphatic malformation. Vasc Endovascular Surg. 2005;39(1):67–81.CrossRefPubMedGoogle Scholar
  20. 20.
    Lee BB et al. Supplemental surgical treatment to end stage (stage IV-V) of chronic lymphedema. Int Angiol. 2008;27(5):389–95.PubMedGoogle Scholar
  21. 21.
    Cormier JN et al. The surgical treatment of lymphedema: a systematic review of the contemporary literature (2004-2010). Ann Surg Oncol. 2012;19(2):642–51.CrossRefPubMedGoogle Scholar
  22. 22.
    Brorson H et al. Quality of life following liposuction and conservative treatment of arm lymphedema. Lymphology. 2006;39(1):8–25.PubMedGoogle Scholar
  23. 23.
    Qi F et al. Treatment of upper limb lymphedema with combination of liposuction, myocutaneous flap transfer, and lymph-fascia grafting: a preliminary study. Microsurgery. 2009;29(1):29–34.CrossRefPubMedGoogle Scholar
  24. 24.
    Damstra RJ et al. Circumferential suction-assisted lipectomy for lymphoedema after surgery for breast cancer. Br J Surg. 2009;96(8):859–64.CrossRefPubMedGoogle Scholar
  25. 25.
    Goldsmith HS. Long term evaluation of omental transposition for chronic lymphedema. Ann Surg. 1974;180(6):847–9.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Jacobson 2nd JH, Suarez EL. Microvascular surgery. Dis Chest. 1962;41:220–4.CrossRefPubMedGoogle Scholar
  27. 27.
    Koshima, I., et al., Ultrastructural observations of lymphatic vessels in lymphedema in human extremities. Plast Reconstr Surg, 1996. 97(2): p. 397–405; discussion 406–7.Google Scholar
  28. 28.
    Campisi C et al. Microsurgery for lymphedema: clinical research and long-term results. Microsurgery. 2010;30(4):256–60.PubMedGoogle Scholar
  29. 29.
    Koshima I et al. Supramicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the extremities. Nihon Geka Gakkai Zasshi. 1999;100(9):551–6.PubMedGoogle Scholar
  30. 30.
    Yamamoto Y et al. Follow-up study of upper limb lymphedema patients treated by microsurgical lymphaticovenous implantation (MLVI) combined with compression therapy. Microsurgery. 2003;23(1):21–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg. 2013;132(5):1305–14.CrossRefPubMedGoogle Scholar
  32. 32.
    Tobbia D et al. Experimental assessment of autologous lymph node transplantation as treatment of postsurgical lymphedema. Plast Reconstr Surg. 2009;124(3):777–86.CrossRefPubMedGoogle Scholar
  33. 33.
    Henry SL, Cheng M-H. Recipient site selection in vascularized lymph node flap transfer. In: Cheng M-H, Chang DW, Patel KM, editors. Principles and practice of lymphedema surgery. Edinburgh: Elsevier; 2016. p. 113–21.Google Scholar
  34. 34.
    Cromwel KD, Armer JM, Cormier JN. Evidence-based outcomes. In: Cheng M-H, Chang DW, Patel KM, editors. Microsurgical procedures: Lymphovenous anastomosis techniques. Philadelphia: Elsevier; 2016. p. 191–202.Google Scholar
  35. 35.
    Modolin M, et al. Surgical treatment of lymphedema of the penis and scrotum. Clinics (Sao Paulo). 2006;61(4):289–94.CrossRefGoogle Scholar
  36. 36.
    Salgado CJ, et al. Radical reduction of upper extremity lymphedema with preservation of perforators. Ann Plast Surg. 2009;63(3):302–6.CrossRefPubMedGoogle Scholar
  37. 37.
    van der Walt JC, et al. Modified Charles procedure using negative pressure dressings for primary lymphedema: a functional assessment. Ann Plast Surg. 2009;62(6):669–75.CrossRefPubMedGoogle Scholar
  38. 38.
    Karri V, et al. Optimizing outcome of charles procedure for chronic lower extremity lymphoedema. Ann Plast Surg. 2011;66(4):393–402.CrossRefPubMedGoogle Scholar
  39. 39.
    Liu Q, Zhou X, Wei Q. Treatment of upper limb lymphedema after radical mastectomy with liposuction technique and pressure therapy. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2005;19(5):344–5.PubMedGoogle Scholar
  40. 40.
    Schaverien MV, et al. Liposuction for chronic lymphoedema of the upper limb: 5 years of experience. J Plast Reconstr Aesthet Surg. 2012;65(7):935–42.CrossRefPubMedGoogle Scholar
  41. 41.
    Granzow JW, et al. An effective system of surgical treatment of lymphedema. Ann Surg Oncol. 2014;21(4):1189–94.CrossRefPubMedGoogle Scholar
  42. 42.
    Weiss M, Baumeister RG, Hahn K. Post-therapeutic lymphedema: scintigraphy before and after autologous lymph vessel transplantation: 8 years of long-term follow-up. Clin Nucl Med. 2002;27(11):788–92.CrossRefPubMedGoogle Scholar
  43. 43.
    Wongtrungkapun R. Microsurgical lymphonodovenous implantation for chronic lymphedema. J Med Assoc Thai. 2004;87(8):877–82.PubMedGoogle Scholar
  44. 44.
    Becker C, et al. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg. 2006;243(3):313–5.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Belcaro G, et al. Lymphatic tissue transplant in lymphedema–a minimally invasive, outpatient, surgical method: a 10-year follow-up pilot study. Angiology. 2008;59(1):77–83.CrossRefPubMedGoogle Scholar
  46. 46.
    Hou C, Wu X, Jin X. Autologous bone marrow stromal cells transplantation for the treatment of secondary arm lymphedema: a prospective controlled study in patients with breast cancer related lymphedema. Jpn J Clin Oncol. 2008;38(10):670–4.CrossRefPubMedGoogle Scholar
  47. 47.
    Lin CH, et al. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Plast Reconstr Surg. 2009;123(4):1265–75.CrossRefPubMedGoogle Scholar
  48. 48.
    Gharb BB, et al. Vascularized lymph node transfer based on the hilar perforators improves the outcome in upper limb lymphedema. Ann Plast Surg. 2011;67(6):589–93.CrossRefPubMedGoogle Scholar
  49. 49.
    Cheng MH, et al. A novel approach to the treatment of lower extremity lymphedema by transferring a vascularized submental lymph node flap to the ankle. Gynecol Oncol. 2012;126(1):93–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Cheng MH, et al. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes. Plast Reconstr Surg. 2013;131(6):1286–98.CrossRefPubMedGoogle Scholar
  51. 51.
    Koshima I, et al. Minimal invasive lymphaticovenular anastomosis under local anesthesia for leg lymphedema: is it effective for stage III and IV? Ann Plast Surg. 2004;53(3):261–6.CrossRefPubMedGoogle Scholar
  52. 52.
    Matsubara S, et al. Long-term results of microscopic lymphatic vessel-isolated vein anastomosis for secondary lymphedema of the lower extremities. Surg Today. 2006;36(10):859–64.CrossRefPubMedGoogle Scholar
  53. 53.
    Damstra RJ, et al. 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. 2010;113(2):199–206.CrossRefGoogle Scholar
  54. 54.
    Demirtas Y, et al. Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Microsurgery. 2009;29(8):609–18.CrossRefPubMedGoogle Scholar
  55. 55.
    Chang DW. Lymphaticovenular bypass for lymphedema management in breast cancer patients: a prospective study. Plast Reconstr Surg. 2010;126(3):752–8.CrossRefPubMedGoogle Scholar
  56. 56.
    Maegawa J, et al. Types of lymphoscintigraphy and indications for lymphaticovenous anastomosis. Microsurgery. 2010;30(6):437–42.CrossRefPubMedGoogle Scholar
  57. 57.
    Mihara M, et al. Regional diagnosis of lymphoedema and selection of sites for lymphaticovenular anastomosis using elastography. Clin Radiol. 2011;66(8):715–9.CrossRefPubMedGoogle Scholar
  58. 58.
    Narushima M, et al. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg. 2010;125(3):935–43.CrossRefPubMedGoogle Scholar
  59. 59.
    Furukawa H, et al. Microsurgical lymphaticovenous implantation targeting dermal lymphatic backflow using indocyanine green fluorescence lymphography in the treatment of postmastectomy lymphedema. Plast Reconstr Surg. 2011;127(5):1804–11.CrossRefPubMedGoogle Scholar
  60. 60.
    Yamamoto T, et al. Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis. Plast Reconstr Surg. 2011;127(5):1987–92.CrossRefPubMedGoogle Scholar
  61. 61.
    Auba C, et al. Lymphaticovenular anastomoses for lymphedema treatment: 18 months postoperative outcomes. Microsurgery. 2012;32(4):261–8.CrossRefPubMedGoogle Scholar
  62. 62.
    Mihara M, et al. Scarless lymphatic venous anastomosis for latent and early-stage lymphoedema using indocyanine green lymphography and non-invasive instruments for visualising subcutaneous vein. J Plast Reconstr Aesthet Surg. 2012;65(11):1551–8.CrossRefPubMedGoogle Scholar
  63. 63.
    Ayestaray B, Bekara F, Andreoletti JB. pi-shaped lymphaticovenular anastomosis for head and neck lymphoedema: a preliminary study. J Plast Reconstr Aesthet Surg. 2013;66(2):201–6.CrossRefPubMedGoogle Scholar
  64. 64.
    Boccardo F, et al. Surgical prevention and treatment of lymphedema after lymph node dissection in patients with cutaneous melanoma. Lymphology. 2013;46(1):20–6.PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Vascular SurgerySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
  2. 2.Division of Transplantation and Vascular Surgery, Department of SurgeryInternational St. Mary’s Hospital, Catholic Kwandong University College of MedicineIncheonSouth Korea

Personalised recommendations