Advances in surgical treatment of lymphedema

Maureen Beederman; David W. Chang

doi:10.5999/aps.2021.01445

Archives of Plastic Surgery, Table of Contents

CC BY-NC 4.0 · Arch Plast Surg 2021; 48(06): 670-677
DOI: 10.5999/aps.2021.01445

Extremity/Lymphedema

Review Article

Advances in surgical treatment of lymphedema

Authors

Maureen Beederman

Section of Plastic and Reconstructive Surgery, The University of Chicago, Chicago, IL, USA
David W. Chang

Section of Plastic and Reconstructive Surgery, The University of Chicago, Chicago, IL, USA

Abstract

An estimated 250 million people worldwide suffer from lymphedema. In the past, the firstline option for treatment was nonsurgical management, either in the form of compression garments or wrapping, or comprehensive decongestive therapy, with debulking surgery reserved for the more advanced cases. However, with improvements in microsurgical techniques and imaging modalities, surgical intervention is increasingly being utilized. This review highlights recent advancements in the surgical treatment of lymphedema, specifically focusing on improvements in imaging, surgical techniques, and prevention of lymphedema.

Keywords

Lymphedema - Surgery - Microsurgery - Advances - Treatment

Full Text

References

REFERENCES
1 Rockson SG, Rivera KK. Estimating the population burden of lymphedema. Ann N Y Acad Sci 2008; 1131: 147-54
2 Charles RH. The surgical treatment of elephantiasis. Ind Med Gaz 1901; 36: 84-99
3 Chang DW, Masia J, Garza 3rd R. et al. Lymphedema: surgical and medical therapy. Plast Reconstr Surg 2016; 138 (Suppl. 03) 209S-218S
4 Suami H, Chang DW. Overview of surgical treatments for breast cancer-related lymphedema. Plast Reconstr Surg 2010; 126: 1853-63
5 Beederman M, Garza RM, Agarwal S. et al. Outcomes for physiologic microsurgical treatment of secondary lymphedema involving the extremity. Ann Surg. 01.09.2020; [Epub].
6 Schaverien MV, Asaad M, Selber JC. et al. Outcomes of vascularized lymph node transplantation for treatment of lymphedema. J Am Coll Surg 2021; 232: 982-94
7 Brazio PS, Nguyen DH. Combined liposuction and physiologic treatment achieves durable limb volume normalization in class II-III lymphedema: a treatment algorithm to optimize outcomes. Ann Plast Surg. 2021. 86 (5S Suppl 3). S384-9
8 Chang DW, Dayan J, Greene AK. et al. Surgical treatment of lymphedema: a systematic review and meta-analysis of controlled trials: results of a consensus conference. Plast Reconstr Surg 2021; 147: 975-93
9 Kwon JG, Hong DW, Suh HP. et al. Patient-specific surgical options for breast cancer-related lymphedema: technical tips. Arch Plast Surg 2021; 48: 246-53
10 Schaverien MV, Coroneos CJ. Surgical treatment of lymphedema. Plast Reconstr Surg 2019; 144: 738-58
11 Hayashi A, Yamamoto T, Yoshimatsu H. et al. Ultrasound visualization of the lymphatic vessels in the lower leg. Microsurgery 2016; 36: 397-401
12 Hayashi A, Hayashi N, Yoshimatsu H. et al. Effective and efficient lymphaticovenular anastomosis using preoperative ultrasound detection technique of lymphatic vessels in lower extremity lymphedema. J Surg Oncol 2018; 117: 290-8
13 Hayashi A, Giacalone G, Yamamoto T. et al. Ultra high-frequency ultrasonographic imaging with 70 MHz scanner for visualization of the lymphatic vessels. Plast Reconstr Surg Glob Open 2019; 7: e2086
14 Dayan JH, Wiser I, Verma R. et al. Regional patterns of fluid and fat accumulation in patients with lower extremity lymphedema using magnetic resonance angiography. Plast Reconstr Surg 2020; 145: 555-63
15 Dayan JH, Dayan E, Kagen A. et al. The use of magnetic resonance angiography in vascularized groin lymph node transfer: an anatomic study. J Reconstr Microsurg 2014; 30: 41-5
16 Yasunaga Y, Nakajima Y, Mimura S. et al. Magnetic resonance lymphography as three-dimensional navigation for lymphaticovenular anastomosis in patients with leg lymphedema. J Plast Reconstr Aesthet Surg 2021; 74: 1253-60
17 Forte AJ, Boczar D, Huayllani MT. et al. Use of magnetic resonance imaging lymphangiography for preoperative planning in lymphedema surgery: a systematic review. Microsurgery 2021; 41: 384-90
18 Cha HG, Oh TM, Cho MJ. et al. Changing the paradigm: lymphovenous anastomosis in advanced stage lower extremity lymphedema. Plast Reconstr Surg 2021; 147: 199-207
19 Ciudad P, Manrique OJ, Adabi K. et al. Combined double vascularized lymph node transfers and modified radical reduction with preservation of perforators for advanced stages of lymphedema. J Surg Oncol 2019; 119: 439-48
20 Agko M, Ciudad P, Chen HC. Staged surgical treatment of extremity lymphedema with dual gastroepiploic vascularized lymph node transfers followed by suction-assisted lipectomy: a prospective study. J Surg Oncol 2018; 117: 1148-56
21 Cheng MH, Loh CY, Lin CY. Outcomes of vascularized lymph node transfer and lymphovenous anastomosis for treatment of primary lymphedema. Plast Reconstr Surg Glob Open 2018; 6: e2056
22 Agarwal S, Garza RM, Chang DW. Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the prevention of secondary lymphedema. Breast J 2020; 26: 721-4
23 Boccardo F, Casabona F, De Cian F. et al. Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy. Ann Surg Oncol 2009; 16: 703-8
24 Boccardo F, Casabona F, De Cian F. et al. Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: over 4 years follow-up. Microsurgery 2014; 34: 421-4
25 Coriddi M, Mehrara B, Skoracki R. et al. Immediate lymphatic reconstruction: technical points and literature review. Plast Reconstr Surg Glob Open 2021; 9: e3431
26 Johnson AR, Fleishman A, Granoff MD. et al. Evaluating the impact of immediate lymphatic reconstruction for the surgical prevention of lymphedema. Plast Reconstr Surg 2021; 147: 373e-381e
27 Feldman S, Bansil H, Ascherman J. et al. Single institution experience with Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the primary prevention of lymphedema. Ann Surg Oncol 2015; 22: 3296-301
28 Jorgensen MG, Toyserkani NM, Sorensen JA. The effect of prophylactic lymphovenous anastomosis and shunts for preventing cancer-related lymphedema: a systematic review and meta-analysis. Microsurgery 2018; 38: 576-85
29 Bucci LK, Brunelle CL, Bernstein MC. et al. Subclinical lymphedema after treatment for breast cancer: risk of progression and considerations for early intervention. Ann Surg Oncol 11.06.2021; [Epub].
30 Morotti M, Menada MV, Boccardo F. et al. Lymphedema microsurgical preventive healing approach for primary prevention of lower limb lymphedema after inguinofemoral lymphadenectomy for vulvar cancer. Int J Gynecol Cancer 2013; 23: 769-74
31 Cakmakoglu C, Kwiecien GJ, Schwarz GS. et al. Lymphaticovenous bypass for immediate lymphatic reconstruction in locoregional advanced melanoma patients. J Reconstr Microsurg 2020; 36: 247-52
32 Boccardo F, Valenzano M, Costantini S. et al. LYMPHA technique to prevent secondary lower limb lymphedema. Ann Surg Oncol 2016; 23: 3558-63