Granzow JW
Clinical & experimental metastasis. Date of publication 2018 Aug 1;volume 35(5-6):553-558.
1. Clin Exp Metastasis. 2018 Aug;35(5-6):553-558. doi: 10.1007/s10585-018-9897-7.
Epub 2018 Jul 6.
Lymphedema surgery: the current state of the art.
Granzow JW(1).
Author information:
(1)Harbor-UCLA Division of Plastic Surgery, Torrance, CA, USA.
drjay@lymphedemasurgeon.com.
BACKGROUND/PURPOSE: Lymphedema surgery, when integrated into a comprehensive
lymphedema treatment program for patients, can provide effective and long-term
improvements that non-surgical management alone cannot achieve. Such a treatment
program can provide significant improvement for many issues such as recurring
cellulitis infections, inability to wear clothing appropriate for the rest of
their body size, loss of function of arm or leg, and desire to decrease the
amount of lymphedema therapy and compression garment use.
METHODS: The fluid predominant portion of lymphedema may be treated effectively
with surgeries that involve transplantation of lymphatic tissue, called
vascularized lymph node transfer (VLNT), or involve direct connections from the
lymphatic system to the veins, called lymphaticovenous anastomoses (LVA). VLNT
and LVA are microsurgical procedures that can improve the patient's own
physiologic drainage of the lymphatic fluid, and we have seen the complete
elimination for the need of compression garments in some of our patients. These
procedures tend to have better results when performed when a patient's lymphatic
system has less damage. The stiff, solid-predominant swelling often found in
later stages of lymphedema can be treated effectively with a surgery called
suction-assisted protein lipectomy (SAPL). SAPL surgeries allow removal of
lymphatic solids and fatty deposits that are otherwise poorly treated by
conservative lymphedema therapy, VLNT or LVA surgeries.
CONCLUSION: Overall, multiple effective surgical options for lymphedema exist.
Surgical treatments should not be seen as a "quick fix", and should be pursued in
the framework of continuing lymphedema therapy and treatment to optimize each
patient's outcome. When performed by an experienced lymphedema surgeon as part of
an integrated system with expert lymphedema therapy, safe, consistent and
long-term improvements can be achieved.
DOI: 10.1007/s10585-018-9897-7
PMID: 29980891
Appears in following Topics:
