Clinical progress of microsurgical management for lymphedema_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Shiqiang ,  MA Xianjie

Department of Plastic and Reconstructive Surgery, Xijing Hospital, Air Force Military Medical University, Xi’an Shaanxi, 710032, P.R.China;

Corresponding author：

MA Xianjie, Email: majing@fmmu.edu.cn

Keywords：

Lymphedema; microsurgery; lymphatic-venous anastomosis; lymph node transfer

DOI：

10.7507/1002-1892.201803018

Video：

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Objective To review the clinical progress of microsurgical management for lymphedema. Methods The literature on microsurgical treatment for lymphedema at home and abroad in recent years was reviewed and analyzed. Results At present, conservative treatment is the main treatment for lymphedema, which has limited effectiveness only for early stages of lymphedema; and it is not curative and demands patient compliance. In contrast, microsurgical approaches can solve the problems in the prevention or management of lymphedema and showed promising results, such as lymphatic-venous anastomosis (LVA), vascularized lymph node transfer (VLNT), and other lymphatic reconstructions. Conclusion Microsurgical approaches like LVA and VLNT have been broadly used in recent years, the effectiveness and safety have been proved. But the evidence of long-term randomized controlled studies is still required to establish standard treatment practices.

Citation： LIU Shiqiang, MA Xianjie. Clinical progress of microsurgical management for lymphedema. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(9): 1223-1226. doi: 10.7507/1002-1892.201803018 Copy

1.	Amore M, Tapia L, Mercado D, et al. Lymphedema: A general outline of its anatomical base. J Reconstr Microsurg, 2016, 32(1): 2-9.
2.	Sosin M, Yin C, Poysophon P, et al. Understanding the concepts and physiologic principles of lymphatic microsurgery. J Reconstr Microsurg, 2016, 32(8): 571-579.
3.	Yüksel A, Gürbüz O, Velioğlu Y, et al. Management of lymphoedema. Vasa, 2016, 45(4): 283-291.
4.	Allen RJ, Cheng MH. Lymphedema surgery: Patient selection and an overview of surgical techniques. J Surg Oncol, 2016, 113(8): 923-931.
5.	Masia J, Olivares L, Koshima I, et al. Barcelona consensus on supermicrosurgery. J Reconstr Microsurg, 2014, 30(1): 53-58.
6.	Sedlácek J. Lymphovenous shunt as supplementary treatment of elephantiasis of lower limbs. Acta Chir Plast, 1969, 11(2): 157-162.
7.	Silva AK, Chang DW. Vascularized lymph node transfer and lymphovenous bypass: Novel treatment strategies for symptomatic lymphedema. J Surg Oncol, 2016, 113(8): 932-939.
8.	Koshima I, Yamamoto T, Narushima M, et al. Perforator flaps and supermicrosurgery. Clin Plast Surg, 2010, 37(4): 683-689.
9.	Hara H, Mihara M, Ohtsu H, et al. Indication of lymphaticovenous anastomosis for lower limb primary lymphedema. Plast Reconstr Surg, 2015, 136(4): 883-893.
10.	Akita S, Mitsukawa N, Kuriyama M, et al. Suitable therapy options for sub-clinical and early-stage lymphoedema patients. J Plast Reconstr Aesthet Surg, 2014, 67(4): 520-525.
11.	Boccardo F, Casabona F, De Cian F, et al. Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: over 4 years follow-up. Microsurgery, 2014, 34(6): 421-424.
12.	Ayestaray B, Bekara F. π-shaped lymphaticovenular anastomosis: the venous flow sparing technique for the treatment of peripheral lymphedema. J Reconstr Microsurg, 2014, 30(8): 551-560.
13.	Maegawa J, Yabuki Y, Tomoeda H, et al. Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema. J Vasc Surg, 2012, 55(3): 753-760.
14.	Boccardo F, Fulcheri E, Villa G, et al. Lymphatic microsurgery to treat lymphedema: techniques and indications for better results. Ann Plast Surg, 2013, 71(2): 191-195.
15.	Campisi CC, Ryan M, Boccardo F, et al. A single-site technique of multiple lymphatic-venous anastomoses for the treatment of peripheral lymphedema: Long-term clinical outcome. J Reconstr Microsurg, 2016, 32(1): 42-49.
16.	Mihara M, Hara H, Furniss D, et al. Lymphaticovenular anastomosis to prevent cellulitis associated with lymphoedema. Br J Surg, 2014, 101(11): 1391-1396.
17.	Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg, 2013, 132(5): 1305-1314.
18.	Clodius L, Smith PJ, Bruna J, et al. The lymphatics of the groin flap. Ann Plast Surg, 1982, 9(6): 447-458.
19.	Becker C, Assouad J, Riquet M, et al. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg, 2006, 243(3): 313-315.
20.	Lin CH, Ali R, Chen SC, et al. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Plast Reconstr Surg, 2009, 123(4): 1265-1275.
21.	Cheng MH, Huang JJ, Nguyen DH, et al. A novel approach to the treatment of lower extremity lymphedema by transferring a vascularized submental lymph node flap to the ankle. Gynecol Oncol, 2012, 126(1): 93-98.
22.	李平, 何波, 杨羿, 等. 血管化锁骨上窝淋巴结皮瓣移植治疗肢体淋巴水肿近期疗效. 中华显微外科杂志, 2017, 40(3): 218-221.
23.	Saaristo AM, Niemi TS, Viitanen TP, et al. Microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients. Ann Surg, 2012, 255(3): 468-473.
24.	Inbal A, Teven CM, Chang DW. Latissimus dorsi flap with vascularized lymph node transfer for lymphedema treatment: Technique, outcomes, indications and review of literature. J Surg Oncol, 2017, 115(1): 72-77.
25.	Nguyen AT, Chang EI, Suami H, et al. An algorithmic approach to simultaneous vascularized lymph node transfer with microvascular breast reconstruction. Ann Surg Oncol, 2015, 22(9): 2919-2924.
26.	Cheng MH, Chen SC, Henry SL, et al. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes. Plast Reconstr Surg, 2013, 131(6): 1286-1298.
27.	Baumeister RG, Seifert J, Hahn D. Autotransplantation of lymphatic vessels. Lancet, 1981, 1(8212): 147.
28.	Goldsmith HS, De Los Santos R. Omental transposition in primary lymphedema. Surg Gynecol Obstet, 1967, 125(3): 607-610.
29.	Nguyen AT, Suami H. Laparoscopic free omental lymphatic flap for the treatment of lymphedema. Plast Reconstr Surg, 2015, 136(1): 114-118.

1. Amore M, Tapia L, Mercado D, et al. Lymphedema: A general outline of its anatomical base. J Reconstr Microsurg, 2016, 32(1): 2-9.
2. Sosin M, Yin C, Poysophon P, et al. Understanding the concepts and physiologic principles of lymphatic microsurgery. J Reconstr Microsurg, 2016, 32(8): 571-579.
3. Yüksel A, Gürbüz O, Velioğlu Y, et al. Management of lymphoedema. Vasa, 2016, 45(4): 283-291.
4. Allen RJ, Cheng MH. Lymphedema surgery: Patient selection and an overview of surgical techniques. J Surg Oncol, 2016, 113(8): 923-931.
5. Masia J, Olivares L, Koshima I, et al. Barcelona consensus on supermicrosurgery. J Reconstr Microsurg, 2014, 30(1): 53-58.
6. Sedlácek J. Lymphovenous shunt as supplementary treatment of elephantiasis of lower limbs. Acta Chir Plast, 1969, 11(2): 157-162.
7. Silva AK, Chang DW. Vascularized lymph node transfer and lymphovenous bypass: Novel treatment strategies for symptomatic lymphedema. J Surg Oncol, 2016, 113(8): 932-939.
8. Koshima I, Yamamoto T, Narushima M, et al. Perforator flaps and supermicrosurgery. Clin Plast Surg, 2010, 37(4): 683-689.
9. Hara H, Mihara M, Ohtsu H, et al. Indication of lymphaticovenous anastomosis for lower limb primary lymphedema. Plast Reconstr Surg, 2015, 136(4): 883-893.
10. Akita S, Mitsukawa N, Kuriyama M, et al. Suitable therapy options for sub-clinical and early-stage lymphoedema patients. J Plast Reconstr Aesthet Surg, 2014, 67(4): 520-525.
11. Boccardo F, Casabona F, De Cian F, et al. Lymphatic microsurgical preventing healing approach (LYMPHA) for primary surgical prevention of breast cancer-related lymphedema: over 4 years follow-up. Microsurgery, 2014, 34(6): 421-424.
12. Ayestaray B, Bekara F. π-shaped lymphaticovenular anastomosis: the venous flow sparing technique for the treatment of peripheral lymphedema. J Reconstr Microsurg, 2014, 30(8): 551-560.
13. Maegawa J, Yabuki Y, Tomoeda H, et al. Outcomes of lymphaticovenous side-to-end anastomosis in peripheral lymphedema. J Vasc Surg, 2012, 55(3): 753-760.
14. Boccardo F, Fulcheri E, Villa G, et al. Lymphatic microsurgery to treat lymphedema: techniques and indications for better results. Ann Plast Surg, 2013, 71(2): 191-195.
15. Campisi CC, Ryan M, Boccardo F, et al. A single-site technique of multiple lymphatic-venous anastomoses for the treatment of peripheral lymphedema: Long-term clinical outcome. J Reconstr Microsurg, 2016, 32(1): 42-49.
16. Mihara M, Hara H, Furniss D, et al. Lymphaticovenular anastomosis to prevent cellulitis associated with lymphoedema. Br J Surg, 2014, 101(11): 1391-1396.
17. Chang DW, Suami H, Skoracki R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg, 2013, 132(5): 1305-1314.
18. Clodius L, Smith PJ, Bruna J, et al. The lymphatics of the groin flap. Ann Plast Surg, 1982, 9(6): 447-458.
19. Becker C, Assouad J, Riquet M, et al. Postmastectomy lymphedema: long-term results following microsurgical lymph node transplantation. Ann Surg, 2006, 243(3): 313-315.
20. Lin CH, Ali R, Chen SC, et al. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Plast Reconstr Surg, 2009, 123(4): 1265-1275.
21. Cheng MH, Huang JJ, Nguyen DH, et al. A novel approach to the treatment of lower extremity lymphedema by transferring a vascularized submental lymph node flap to the ankle. Gynecol Oncol, 2012, 126(1): 93-98.
22. 李平, 何波, 杨羿, 等. 血管化锁骨上窝淋巴结皮瓣移植治疗肢体淋巴水肿近期疗效. 中华显微外科杂志, 2017, 40(3): 218-221.
23. Saaristo AM, Niemi TS, Viitanen TP, et al. Microvascular breast reconstruction and lymph node transfer for postmastectomy lymphedema patients. Ann Surg, 2012, 255(3): 468-473.
24. Inbal A, Teven CM, Chang DW. Latissimus dorsi flap with vascularized lymph node transfer for lymphedema treatment: Technique, outcomes, indications and review of literature. J Surg Oncol, 2017, 115(1): 72-77.
25. Nguyen AT, Chang EI, Suami H, et al. An algorithmic approach to simultaneous vascularized lymph node transfer with microvascular breast reconstruction. Ann Surg Oncol, 2015, 22(9): 2919-2924.
26. Cheng MH, Chen SC, Henry SL, et al. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes. Plast Reconstr Surg, 2013, 131(6): 1286-1298.
27. Baumeister RG, Seifert J, Hahn D. Autotransplantation of lymphatic vessels. Lancet, 1981, 1(8212): 147.
28. Goldsmith HS, De Los Santos R. Omental transposition in primary lymphedema. Surg Gynecol Obstet, 1967, 125(3): 607-610.
29. Nguyen AT, Suami H. Laparoscopic free omental lymphatic flap for the treatment of lymphedema. Plast Reconstr Surg, 2015, 136(1): 114-118.

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