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Semin Plast Surg 2022; 36(04): 260-273
DOI: 10.1055/s-0042-1758691
Review Article

Approach to Lymphedema Management

Walter C. Lin
1   Department of Surgery, The Buncke Clinic, San Francisco, California
,
Bauback Safa
1   Department of Surgery, The Buncke Clinic, San Francisco, California
,
Rudolf F. Buntic
1   Department of Surgery, The Buncke Clinic, San Francisco, California
› Author Affiliations Funding None.
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Abstract

Millions of people worldwide suffer from lymphedema. In developed nations, lymphedema most commonly stems secondarily from oncologic treatment, but may also result from trauma. More recently, lymphedema has been identified in patients after gender-affirmation phalloplasty reconstruction. Regardless of the etiology, the underlying pathophysiology involves blockage of lymphatic flow, resulting in lymph stasis, thus triggering a cascade of inflammation culminating in fibrosis and adipose deposition. Recent technical advances led to the refinement of physiologic and reductive surgeries—including lymphovenous anastomosis and free functional lymphatic transfer, which collectively encompass a variety of flap procedures including lymph node transfer, lymph channel transfer, and lymphatic system transfer. This article provides a summary of our approach in the assessment and management of the lymphedema patient, including detailed intraoperative photography and imaging, in addition to advanced technical considerations in physiologic reconstruction.

Keywords

lymphedema - lymphovenous anastomosis - lymphovenous bypass - supermicrosurgery - VLNT - vascularized lymph node transfer - LYST - VLCT - VLVT - FFLT - free functional lymphatic transfer


Publication History

Article published online:
16 November 2022

© 2022. Thieme. All rights reserved.

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