Outcomes for Physiologic Microsurgical Treatment of Secondary Lymphedema Involving the Extremity

• Published in: Annals of surgery Vol. 276; no. 4; p. e255
• Main Authors: Beederman, Maureen, Garza, Rebecca M, Agarwal, Shailesh, Chang, David W
• Format: Journal Article
• Language: English
• Published: United States 01.10.2022
• Subjects: Humans; Lower Extremity - surgery; Lymph Nodes - surgery; Lymphedema - etiology; Lymphedema - surgery; Microsurgery; Surgical Flaps - surgery; Upper Extremity
• ISSN: 1528-1140
• DOI: 10.1097/SLA.0000000000004457

The aim of this study was to examine the long-term impact of physiologic surgical options, including VLNT and LVB, on patients with secondary lymphedema of the upper or lower extremity (UEL/LEL). VLNT and LVB have become increasingly popular in the treatment of lymphedema. However, there is a paucity of long-term data on patient outcomes after use of these techniques to treat lymphedema. An analysis of prospectively collected data on all patients who underwent physiologic surgical treatment of secondary lymphedema over a 5.5-year period was performed. Patient demographics, surgical details, subjective reported improvements, LLIS scores, and postoperative limb volume calculations were analyzed. Two hundred seventy-four patients with secondary lymphedema (197 upper, 77 lower) were included in the study. More than 87% of UEL patients and 60% of LEL patients had reduction in excess limb volume postoperatively. At 3 months postoperatively, patients with UEL had a 31.1% reduction in volume difference between limbs, 33.9% at 6 months, 25.7% at 12 months, 47.4% at 24 months and 47.7% at 4 years. The reduction in limb volume difference followed a similar pattern but was overall lower for LEL patients. Greater than 86% of UEL and 75% of LEL patients also had improvement in LLIS scores postoperatively. Fifty-nine complications occurred (12.9%); flap survival was >99%. Patients with secondary UEL/LEL who undergo VLNT/LVB demonstrate improved functional status and reduced affected limb volumes postoperatively. Patients with UEL seem to have a more substantial reduction in limb volume differential compared to LEL patients.