19 Review of the Current Literature

Mario F. Scaglioni and Matteo Meroni

Summary

This chapter will highlight the current scientific evidence available that describes the different surgical procedures to be used to treat lymphedema. Since comparative studies are still infrequent, most studies available nowadays are more or less big case series and expert opinion based on personal experience and, therefore, the level of evidence is rather low. Yet, over the last years, the surgical management of lymphedema has undergone a true revival, particularly with regard to reconstructive microsurgery and therefore resulted in a continuous increase in scientific evidence. This chapter summarizes the current state of pre-, intra-, and postoperative visualization and monitoring of the lymphatic vascular system. Further, it highlights the currently used surgical procedures, both when offering lymphoablative surgery and reconstructive surgery, as a standalone procedure or in combination. It also highlights reconstructive surgery in a prophylactic setting, i.e., while performing lymph node dissection during oncological surgery, and finally describes potential therapeutical approaches based on scientific consensus.

Key words

diagnostics in lymphedema - lymphoablative surgery - lymphovenous anastomosis (LVA) - lymph node vein anastomosis (LNVA) - nonvascularized lymph vessel transfer - reconstructive surgery - suction-assisted lipectomy - vascularized lymph node transfer (VLNT)

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