Open Access
CC BY 4.0 · Arch Plast Surg 2024; 51(02): 212-233
DOI: 10.1055/a-2253-9859
Extremity/Lymphedema
Review Article

Surgical Treatment for Primary Lymphedema: A Systematic Review of the Literature

Miguel Angel Gaxiola-García 
1   Plastic and Reconstructive Surgery Department, Mexico's Children's Hospital (Hospital Infantil de México “Federico Gómez”), Mexico City, Mexico
,
Joseph M. Escandón 
2   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
,
Oscar J. Manrique 
2   Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
,
Kristin A. Skinner
3   Department of Surgical Oncology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
,
Beatriz Hatsue Kushida-Contreras 
4   Plastic and Reconstructive Surgery Department, Mexico's General Hospital (Hospital General de México), Mexico City, Mexico
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Funding None.
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Abstract

This is a retrospective review of surgical management for primary lymphedema.

Data were extracted from 55 articles from PubMed MEDLINE, Web of Science, SCOPUS, and Cochrane Central Register of Controlled Trials between the database inception and December 2022 to evaluate the outcomes of lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), and outcomes of soft tissue extirpative procedures such as suction-assisted lipectomy (SAL) and extensive soft tissue excision.

Data from 485 patients were compiled; these were treated with LVA (n = 177), VLNT (n = 82), SAL (n = 102), and excisional procedures (n = 124). Improvement of the lower extremity lymphedema index, the quality of life (QoL), and lymphedema symptoms were reported in most studies. LVA and VLNT led to symptomatic relief and improved QoL, reaching up to 90 and 61% average circumference reduction, respectively. Cellulitis reduction was reported in 25 and 40% of LVA and VLNT papers, respectively. The extirpative procedures, used mainly in patients with advanced disease, also led to clinical improvement from the volume reduction, as well as reduced incidence of cellulitis, although with poor cosmetic results; 87.5% of these reports recommended postoperative compression garments. The overall complication rates were 1% for LVA, 13% for VLNT, 11% for SAL, and 46% for extirpative procedures. Altogether, only one paper lacked some kind of improvement.

Primary lymphedema is amenable to surgical treatment; the currently performed procedures have effectively improved symptoms and QoL in this population. Complication rates are related to the invasiveness of the chosen procedure.

Keywords

lymphedema - primary lymphedema - congenital lymphedema - lymphovenous anastomosis - lymph node transplant

Authors' Contributions

M.A.G-G. was responsible for conception and design of the work, theoretical framework, analysis and interpretation of data, drafting, and revisions.


J.M.E. was responsible for acquisition and interpretation of data, statistical analysis, drafting and substantial revisions.


O.J.M. was responsible for conception of the work, acquisition and interpretation of data, drafting and substantial revisions.


K.A.S. was responsible for analysis and interpretation of data, drafting and substantial revisions.


B.H.K-C. was the corresponding author, and was responsible for conception and design of the work, analysis and interpretation of data, drafting, and substantial revisions.


Ethical Approval

Anonymity and confidentiality were preserved.


Statement of institutional review board approval or statement of conforming to the Declaration of Helsinki: The present manuscript did not require IRB approval.


Patient Consent

Not applicable.


Supplementary Material



Publication History

Received: 14 September 2023

Accepted: 30 November 2023

Accepted Manuscript online:
25 January 2024

Article published online:
08 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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