Abstract
Background The microsurgical treatment of lymphedema has been well-studied and has been shown
to be effective, especially in cancer-related lymphedema. Posttraumatic lymphedema
(PTL) is a debilitating condition that remains understudied and underreported, and
surgical techniques for PTL treatment are not well-represented in the literature.
The purpose of this study was to systematically review all published reports of physiologic
surgical interventions for PTL.
Methods A search was conducted on PubMed, MEDLINE, Embase, and Web of Science, from January
1, 2000 to December 6, 2022, using keywords “PTL,” “lymphedema,” and “surgery” to
identify reports of PTL treated with microsurgical lymphatic reconstruction techniques.
PTL cases treated with ablation, debulking, or decongestive therapy were excluded.
Results A total of 18 records that met the inclusion criteria were identified, representing
112 patients who underwent microsurgical operations for PTL. This included 60 cases
of lymph flow restoration (LFR) via lymph axiality and interpositional flap transfer,
29 vascularized lymph node transfers, 11 lymphatic vessel free flaps, 10 lymphovenous
anastomoses (LVAs), and 2 autologous lymphovenous transfers. Outcomes were primarily
reported as clinical improvement or LFR by lymphatic imaging. All studies showed qualitative
improvement of symptoms and reports with quantitative data showed statistically significant
improvements.
Conclusion PTL is currently underrepresented in lymphedema treatment literature, however, our
results show that microsurgical techniques are successful in treating lymphedema in
PTL patients. Increasing awareness of PTL and establishing standardized diagnostic
criteria and treatment options will help clinicians better understand how to diagnose
and treat this condition. Prospective and comparative studies are needed to determine
true prevalence of PTL and optimal treatment strategies.
Keywords
posttraumatic lymphedema - trauma lymphedema - lymphovenous bypass - lymphovenous
anastomosis - vascularized lymph node transfer
