Lymphatic surgery
What is it?
Surgical procedures for lymphedema are divided in ablative and physiologic. In ablative surgery, the soft tissues, which are edematous and fibrotic, above the level of the deep fascia, are surgically removed with either direct excision or by liposuction.
Physiologic methods aim to recreate normal lymphatic patterns or alternative ways for lymph fluid to flow out of the affected limb. Two main physiologic procedures are currently considered effective to treat lymphedema. One is based on the creation of shunts between the congested lymphatic channels and the venous system proximal to the site of lymphatic obstruction. The other relies on the introduction of vascularized adipose tissue flaps which include vascularized lymph nodes to the affected extremity.
When is this procedure indicated?
Surgery is considered if other nonsurgical treatments aren’t effective. Not everyone is a candidate for surgery, but for some patients symptoms can be eased with a surgical procedure.
Currently, ablative methods are reserved for more advanced lymphedema, already undergone architectural changes in the soft tissue, unresponsive to physiologic methods of intervention. In these cases, removing the adipose deposits via liposuction or directly excising the soft tissue is the only effective way that will decrease the size of the limb. Patients should still be considered as candidates for a physiologic procedure if pitting edema is present. Our approach, when needed, combines physiologic procedures and andablative methods to achieve optimal results.
How is it performed?
1. Vascularized lymph node transfer (VLNT) surgery involves harvesting lymph nodes along with their vascular supply from a donor site and transferring this vascularized tissue to the affected extremity as a free tissue transfer using a high-powered microscope, specialized instruments and sutures. A microsurgical anastomosis is performed between the blood vessels of the lymph node flap and the recipient site vessels thus establishing blood flow to the lymph node flap. Donor sites typically used for lymph node harvest include axillary/lateral thoracic lymph nodes, inguinal lymph nodes, submental lymph nodes, supraclavicular lymph nodes.
2. Lymphaticovenular anastomosis (LVA) Lymphaticovenular anastomosis (LVA) or Lymphovenous bypass is a surgical procedure where lymphatic vessels in a lymphedematous limb are connected to nearby small veins and venules using microsurgical and super-microsurgical techniques. This procedure leads to better results in patients who has earlier stage of disease and when more anastomosis are performed. LVAs performed in upper extremity have better inprovement.
3. Liposuction is reserved for non-pitting lymphedema cases, where long-term effects of lymphoedema have resulted in excess fat tissue deposition. Despite liposuction will result in immediate reduction in the affected area, it is essential to continue to wear compression garments, as the limb will swell again if compression is not maintained. This procedure is also suitable as an adjunctive procedure to achieve a final contour for patients who underwent previous lymph node transfer.
4. Debulking operations are performed in order to reduce the amount of fibrofatty tissue that's built up over the course of years with lymphedema.
Recovery
Full recovery is espected one moth after surgery; up to two years to observe long term results (lymphangiogenesis)/ Surgery drammatically improves quality of life with significant modification in terms of volume and weight of the affected limb, reducing dependance from compression therapy
Short-term complications
Depend on the type of procedure. These include, but are not limited to, bleeding, seroma, infection, fluid collection, poor healing. Flap surgery (vascularized lymph node transfer) includes the risk of partial or complete loss of the flap and a loss of sensation at both the donor and reconstruction site.
Long-term complications
A rare complication of vascularized lymph node transfer is donor site lymphedema caused by damage to the donor site lymph nodes. Techniques such as reverse lymphatic mapping are now used to minimize this risk.
Where do we treat it?
Our Departments
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