Surgical treatment of lymphedema

Abstract

Lymphedema is a debilitating and progressive condition, which results in the accumulation of lymphatic fluid within the interstitial compartments of tissues and hypertrophy of adipose tissue due to the impairment of lymphatic circulation. The mainstay of current lymphedema treatment is nonsurgical management such as complex decongestive therapy and compression therapy. Recently, surgical treatment of lymphedema based on microsurgery has been developed to enable the functional recovery of lymphatic drainage and has complemented nonsurgical treatment. Lymphaticovenular anastomosis and vascularized lymph node transfer are representative physiologic surgeries in the treatment of lymphedema. Lymphaticovenular anastomosis is conducted to drain lymphatic fluid from obstructed lymphatic vessels to the venous circulation through surgically created lymphaticovenous shunts. Vascularized lymph node transfer involves harvesting lymph nodes with their vascular supply and transferring this vascularized tissue to the lymphedema lesion as a free flap. In addition to physiologic surgeries, ablative surgeries such as direct excision and liposuction also can be performed, especially for end-stage cases. Indications for surgical treatment vary across institutions. It is important not to delay physiologic surgery in mild to moderate cases of lymphedema.