Abstract ES11-3: Microsurgical treatment of lymphedema
Authors: Chang D 
Published: May 2019

Lymphedema is a chronic, debilitating condition that causes physical and psychological morbidity, affecting up to 250 million people worldwide. In the United States and other developed countries, cancer and its treatments are the most common causes of lymphedema. Lymphedema can evolve into progressive swelling, fibrosis, functional deficits, and chronic infections, thus adversely affecting quality of life and health care costs.

Unfortunately, no definitive treatment for lymphedema currently exists. The advents of microsurgery, and more recently supermicrosurgery, have had a major impact on the evolution of these physiologic procedures, which have gained popularity to help reduce the severity of lymphedema.

Lymphatic Bypass

LVB are typically performed through incisions 2-3 cm in length and the number of bypasses can vary depending on a patient as well as a surgeon. In our prospective study in 100 consecutive patients, we have found that LVB can be effective in reducing lymphedema severity, particularly in patients with early-stage, upper-extremity lymphedema with reasonable amount of intact functioning lymphatic vessels and minimal tissue fibrosis.

One recent technological advance in lymphovenous bypass procedures is the use of indocyanine green (ICG) fluorescence lymphangiography to map lymphatic vessels. ICG fluorescence lymphangiography enables surgeons to locate and make incisions precisely over functional lymphatic vessels for the lymphovenous bypass, substantially reducing operating time and may significantly improve the outcomes of LVB surgeries.

Vascularized Lymph Node Transfer

This procedure aims to bring vascularized tissue and healthy lymph nodes into sites affected by lymphedema. A flap containing lymph nodes can then be harvested typically from either the cervical region, axillary region or from the inguinal region.

One proposed theory for mechanism is that lymphangiogenesis occur via growth factors produced by the transplanted lymph nodes and thereby bridging lymphatic pathways. A second proposed theory of mechanism is that vascularized lymph node transfer act as a lymphatic pump. Recently, simultaneous breast reconstruction using the transverse lower abdominal flap harvested with inguinal lymph nodes have gained popularity as a convenient option for lymphedematous women who desire reconstruction after mastectomy.

Conclusions

Currently there is no cure for lymphedema. Worldwide interest in using microsurgical procedures to treat lymphedema is gaining momentum. However, there is no consensus on the indications for which procedure to perform, when to intervene, or how to comparatively grade outcomes. We need further research and better understanding of lymphatic anatomy and lymphedema pathophysiology. In addition, more prospective and controlled studies are needed to objectively evaluate the outcomes of various treatment methods.

Citation Format: Chang D. Microsurgical treatment of lymphedema [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr ES11-3.