ASO Author Reflections: Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Different-Severities Extremity Lymphedema

Excerpt

The common etiologies of secondary extremity lymphedema are the surgical removal of axillary or pelvic lymph nodes and subsequent radiation for breast or gynecological cancers. Complex decongestive therapy (CDT), including manual lymphatic drainage and life-long compression garments, was the main treatment of choice.1 The disadvantages of CDT include poor compliance, cost, everyday effort, risks of continuous swelling, and episodes of cellulitis. A range of major surgical approaches for the treatment of extremity lymphedema, including Charles’s excisional procedure, liposuction, lymphovenous anastomosis (LVA),2 and vascularized lymph node transplantation (VLNT)3 have gradually developed over recent decades. There is no universal consensus regarding the measurements of lymphedematous limbs, diagnosis, staging or grading of the lymphatic obstruction, indications of each surgical procedure, or outcomes evaluation among different physicians and surgeons. Although the various surgical procedures did not completely cure the extremity lymphedema, they successfully improved the circumference of lymphedematous limbs, decreased episodes of cellulitis, and even eliminated the need to wear compression garments.4 This study aims to evaluate the indications and outcomes of ipsilateral VLNT and contralateral LVA for bilateral extremity lymphedema patients with various severities of lymphedematous limbs.5 …