Lymphedema Milestons and Globalization Lymphedema Milestones in Diagnosis and Treatment The surgical and microsurgical treatment of lymphedema is rapidly evolving with new techniques, improved outcome reporting, and descriptions of more effective treatment strategies. Moving forward within the specialty, a thorough…
Key Points Surgical success can be defined as the downgrading of the patient’s lymphedema grades with improved symptoms, at least a 10% decrease in circumferential difference, a decrease in episodes of cellulitis, and improved quality of life. Surgical cure can…
Key Points Complete decongestive therapy remains the only lymphedema treatment that is supported at the highest level of evidence. Health-related quality of life (QOL) is a multidimensional construct that encompasses physical, functional, emotional, and social well-being parameters. A variety of…
Key Points If there is significant pitting (>8–10 mm in depth) of the lymphedematous limb, conservative treatment (combined physiotherapy) is indicated to remove the lymph and transfer the lymphedema to a non-pitting state, which indicates that any remaining excess volume…
Key Points Treatment of advanced lymphedema remains a challenge in reconstructive surgery. Surgical management with excisional procedures is indicated in select patients when conservative measures have failed. Based on an improved knowledge of vascular anatomy and understanding of perforator flap…
Key Points The Lymphatic Microsurgical Preventative Healing Approach, or immediate lymphatic reconstruction (ILR), is a surgical procedure for the prevention of lymphedema (LE). This procedure is performed by trained microsurgeons in patients at high risk for the development of LE…
Key Points Lymphedema staging Surgical treatment of lymphedema & lymphatic microsurgery SS-MLVA/single site – multiple lymphatic-venous anastomoses MLVLA – multiple lymphatic-venous-lymphatic anastomoses (autologous interpositioned vein graft) CLyFT – complete lymphedema functional treatment FLLA-LVSP/fibro-lipo-lymph-aspiration by lymph vessel sparing procedure BPV test…
Key Points Lymphovenous bypass (LVB) usually requires anastomosing lymphatic vessels less than 0.8 mm in diameter to small subdermal venules. A high-resolution microscope, super-fine instruments and sutures, and the training of supermicrosurgery are the basic requirements for the success of…
Key Points Superficial inguinal lymph nodes targeted for harvest lie between the groin crease and inguinal ligament. The vascular supply of these nodes is typically the superficial circumflex iliac artery. These nodes typically drain the lower abdomen; however, there are…
Key Points The small bowel mesentery represents a donor site for vascularized lymph node transfer that contains numerous and redundant lymph nodes and has reliable anatomy with minimal donor site morbidity. The small bowel mesenteric lymph node flap can usually…