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Current Concepts in the Surgical Management of Lymphedema

Kung, Theodore A. M.D.; Champaneria, Manish C. M.D.; Maki, Jeffrey H. M.D., Ph.D.; Neligan, Peter C. M.D.

Plastic & Reconstructive Surgery: April 2017 - Volume 139 - Issue 4 - p 1003e–1013e
doi: 10.1097/PRS.0000000000003218
CME
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Learning Objectives: After studying this article, the participant should be able to: 1. Discuss the key points in diagnosing lymphedema. 2. Understand the imaging modalities that facilitate diagnosis and surgical planning. 3. Appreciate the indications for both physiologic and ablative procedures. 4. Recognize the potential role of lymphaticovenular anastomosis and vascularized lymph node transfer in the treatment of patients with lymphedema.

Summary: Lymphedema is an incurable disease caused by insufficient lymphatic drainage leading to abnormal accumulation of interstitial fluid within the soft tissues. Although this condition may result from a primary structural defect of the lymphatic system, most cases in developed countries are secondary to iatrogenic causes. The diagnosis of lymphedema can be made readily by performing a clinical history and physical examination and may be confirmed by imaging studies such as lymphoscintigraphy, magnetic resonance lymphangiography, or indocyanine green lymphangiography. Nonsurgical treatment continues to be the mainstay of lymphedema management. However, advances in microsurgical techniques have revolutionized surgical options for treating lymphedema, and emerging evidence suggests that reconstructive methods may be performed to restore lymphatic flow. Procedures such as lymphaticovenular anastomosis and vascularized lymph node transfer can potentially offer a more permanent solution to chronic lymphedema, and initial studies have demonstrated promising results.

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Seattle, Wash.; and Ann Arbor, Mich.

From the Department of Surgery, Division of Plastic Surgery, and the Department of Radiology, University of Washington; and the Division of Plastic Surgery, University of Michigan Health System.

Received for publication December 1, 2015; accepted January 29, 2016.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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Peter C. Neligan, M.D., Division of Plastic Surgery, Center for Reconstructive Surgery, University of Washington Medical Center, 1959 NE Pacific Street, Box 356410, Room BB487, Seattle, Wash. 98195-6410, pneligan@uw.edu

©2017American Society of Plastic Surgeons