Ciudad P, Escandón JM, Manrique OJ, Bustos VP, et al.
Archives of plastic surgery. Date of publication 2022 Apr 6;volume 49(2):227-239.
1. Arch Plast Surg. 2022 Apr 6;49(2):227-239. doi: 10.1055/s-0042-1744412.
eCollection 2022 Mar.
Lessons Learnt from an 11-year Experience with Lymphatic Surgery and a Systematic
Review of Reported Complications: Technical Considerations to Reduce Morbidity.
Ciudad P(1)(2)(3), Escandón JM(4), Manrique OJ(4), Bustos VP(5).
Author information:
(1)Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza
National Hospital, Lima, Peru.
(2)Department of Plastic and Reconstructive Surgery, China Medical University
Hospital, Taichung, Taiwan.
(3)Academic Department of Surgery, School of Medicine Hipolito Unanue, Federico
Villarreal National University, Lima, Perú.
(4)Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital,
University of Rochester Medical Center, Rochester, New York.
(5)Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth
Israel Deaconess Medical Center, Harvard Medical University, Boston,
Massachusetts.
Complications experienced during lymphatic surgery have not been ubiquitously
reported, and little has been described regarding how to prevent them. We present
a review of complications reported during the surgical management of lymphedema
and our experience with technical considerations to reduce morbidity from
lymphatic surgery. A comprehensive search across different databases was
conducted through November 2020. Based on the complications identified, we
discussed the best approach for reducing the incidence of complications during
lymphatic surgery based on our experience. The most common complications reported
following lymphovenous anastomosis were re-exploration of the anastomosis, venous
reflux, and surgical site infection. The most common complications using groin
vascularized lymph node transfer (VLNT), submental VLNT, lateral thoracic VLNT,
and supraclavicular VLNT included delayed wound healing, seroma and hematoma
formation, lymphatic fluid leakage, iatrogenic lymphedema, soft-tissue infection,
venous congestion, marginal nerve pseudoparalysis, and partial flap loss.
Regarding intra-abdominal lymph node flaps, incisional hernia, hematoma,
lymphatic fluid leakage, and postoperative ileus were commonly reported.
Following suction-assisted lipectomy, significant blood loss and transient
paresthesia were frequently reported. The reported complications of excisional
procedures included soft-tissue infections, seroma and hematoma formation,
skin-graft loss, significant blood loss, and minor skin flap necrosis. Evidently,
lymphedema continues to represent a challenging condition; however, thorough
patient selection, compliance with physiotherapy, and an experienced surgeon with
adequate understanding of the lymphatic system can help maximize the safety of
lymphatic surgery.
The Korean Society of Plastic and Reconstructive Surgeons. This is an open access
article published by Thieme under the terms of the Creative Commons
Attribution-NonDerivative-NonCommercial License, permitting copying and
reproduction so long as the original work is given appropriate credit. Contents
may not be used for commercial purposes, or adapted, remixed, transformed or
built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).
DOI: 10.1055/s-0042-1744412
PMCID: PMC9045509
PMID: 35832669
Conflict of interest statement: Conflict of Interest P.C. is an editorial board
member of the journal but was not involved in the peer reviewer selection,
evaluation, or decision process of this article. No other potential conflicts of
interest relevant to this article were reported.
