Surgical Management of Lower Extremity Lymphedema: A Comprehensive Review

Pedro Ciudad; M. Diya Sabbagh; Mouchammed Agko; Tony C.T. Huang; Oscar J. Manrique; Carmen Román L.; Cesar Reynaga; Ricardo Delgado; Michele Maruccia; Hung-Chi Chen

doi:10.1055/s-0039-1688537

Indian Journal of Plastic Surgery, Table of Contents

CC BY-NC-ND 4.0 · Indian J Plast Surg 2019; 52(01): 081-092
DOI: 10.1055/s-0039-1688537

Review Article

Association of Plastic Surgeons of India

Surgical Management of Lower Extremity Lymphedema: A Comprehensive Review

Pedro Ciudad

¹Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru

²Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan

,

M. Diya Sabbagh

³Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, United Sates

,

Mouchammed Agko

⁴Section of Plastic Surgery, Medical College of Georgia, Augusta University, Augusta, Georgia

,

Tony C.T. Huang

³Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, United Sates

,

Oscar J. Manrique

³Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota, United Sates

,

Carmen Román L.

⁵Department of Physical and Rehabilitation Medicine, National Cancer Institute of Peru (INEN), Lima, Peru

,

Cesar Reynaga

¹Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru

,

Ricardo Delgado

⁶Department of Plastic and Reconstructive Surgery, National Cancer Institute of Peru (INEN), Lima, Peru

,

Michele Maruccia

¹Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru

,

Hung-Chi Chen

²Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan

› Author Affiliations

Abstract

Lymphedema refers to the accumulation of protein-rich fluid in the interstitial spaces. This can occur secondary to congenital malformation of the lymphatic channels or nodes or as a result of an insult that damages appropriately formed channels and nodes. Stagnant, protein-rich lymph initiates an inflammatory response that leads to adipocyte proliferation, fibrous tissue deposition, and increased susceptibility to infections. The end result is permanent disfigurement and dermal changes. Early and accurate diagnosis is essential, since lymphedema is a chronic and progressive problem. When lymphedema affects the lower extremity, it is important to manage it in a way that preserves function and mobility. Early diagnosis also allows for a proactive rather than reactive approach to treatment and utilization of novel physiologic procedures, such as lymphovenous anastomosis and vascularized lymph node transfer. Such interventions slow down disease progression and reduce morbidity by allowing the surgeon to salvage the remaining functional lymphatic channels. When physiologic procedures fail or when faced with a delayed presentation, the addition of excisional procedures can provide a more comprehensive treatment of this debilitating disease. The aim of this article is to review the most current concepts in the surgical management of lower extremity lymphedema.

Keywords

lymphedema - vascularized lymph node transfer - radical reduction in lymphedema with preservation of perforators - suction-assisted lipectomy - lower extremity lymphedema

Full Text

References

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