E. I. Chang1, J. Balaicuis1, J. Buhler1, W. Morgan1, A. Nadler1, J. M. Farma1 1Fox Chase Cancer Center,Plastic And Reconstructive Surgery,Philadelphia, PA, USA
Introduction: The incidence of lymphedema has been increasing. There has been increasing enthusiasm and interest for the surgical management of lymphedema in the United States. Currently, the two most common surgical procedures available include vascularized lymph node transplantation (VLNT) and lymphovenous bypass (LVBP). We present our early experience of patients undergoing surgical treatment of lymphedema at a tertiary referral center.
Methods: A retrospective review of a single surgeon experience of all patients undergoing surgical management of lymphedema was performed. Patient demographics including age, cancer type, body mass index (BMI), and history of radiation treatment were recorded, as well as, postoperative outcomes.
Results:A total of 30 procedures were performed in 28 patients for the surgical management of lymphedema. All patients had grade II-III lymphedema and the majority had received radiation (75.0%). Treatment for breast cancer was the most common etiology for developing lymphedema in this series (n=15, 53.6%) followed by gynecologic malignancies (n=5, 17.9%) and sarcoma (n=4, 14.3%). Seven patients underwent VLNT using the supraclavicular lymph node basin and 16 patients had LVBP performed. Seven patients underwent simultaneous vascularized lymph node transfer in conjunction with autologous tissue breast reconstruction. All patients reported subjective improvement of the lymphedema after surgery (100%) with decreased episodes of cellulitis. The average measurable reduction was 76.4% (19.5%-320.0%) over an average follow-up of 7.8 months. Two patients undergoing VLNT experienced major complications requiring operative intervention (9.1%).
Conclusion:VLNT and LVBP are safe and effective strategies for the surgical management of lymphedema with early excellent results regardless of the type of malignancy. This technique provides a novel treatment option that could benefit all patients with lymphedema. Further studies with longer follow-up are necessary to evaluate the advantages between the two surgical techniques.