Surgical Techniques for Lymphedema Management

Matthew Kayal, Shelley DiCecco, Shelley Dicecco

Research output: Contribution to conferencePresentation

Abstract

Introduction: Lymphedema is known as a debilitating disease where the management plan can require a combination of surgical and conservative treatments. Worldwide, greater than 300 million people suffer from lymphedema. The lymphatic system is responsible for the drainage of fluid from the interstitial tissues and organ systems and is the body’s primary way of managing edema. The aim of this review was to investigate the efficacy of the procedures and the multiple surgical options that exist for the treatment of lymphedema, including the Charles procedure, liposuction or suction-assisted protein lipectomy (SAPL), lymphovenous anastomosis (LVA), and vascularized lymph node transfer (VLNT).

Methods: A comprehensive review of 7 major medical indices (Springer, Nature, Science direct, Google Scholar, Wiley, PubMed, Elsevier) was performed on the available surgical options and treatment. Search queries were filtered to select articles pertaining to the surgical treatment of lymphedema, including the Charles procedure, liposuction or suction-assisted protein lipectomy (SAPL), lymphovenous anastomosis (LVA), and vascularized lymph node transfer (VLNT).

Results: The Charles procedure and the SAPL are both debulking options for treating lymphedema. The Charles procedure is an invasive method that includes the removal of the skin and subcutaneous tissue, while the SAPL removes only adipose tissue. The less invasive nature of the SAPL means fewer cosmetic changes to the limb and a reduced to no inpatient stay for the patient. The LVA and VLNT are both microsurgeries developed to address the altered lymphatic drainage in the involved area. The less invasive LVA connects the functioning lymph vessels in the area to venules to use the venous system as a conduit for lymphatic fluid removal but needs more long-term studies on the patency of the connection. The VLNT al studentstransfers lymph nodes from a functioning donor site to the involved area to stimulate lymphangiogenesis; yet, may cause lymphatic dysfunction at the donor site. Graphic representations were created for the average volume reduction, limb circumference, and quality of life for the respective procedures.

Conclusion: Surgical treatment should be directed at optimizing the management of lymphedema. There is not one perfect option for treating lymphedema, however, a comprehensive therapy utilizing both surgical and non-surgical approaches to lymphedema allows for the most marked improvements in patients dealing with lymphedema.

Original languageAmerican English
StatePublished - May 10 2021

Keywords

  • lymphedema
  • LVA
  • VLNT
  • SAPL
  • Charles procedure

Disciplines

  • Life Sciences
  • Medicine and Health Sciences

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