Arch Hand Microsurg.  2021 Mar;26(1):33-42. 10.12790/ahm.20.0055.

Surgical Management of Lymphedema: An Overview of Preoperative Evaluation and Surgical Techniques

• Suh HP
• Pak CJ
• Hong JP

• KMID: 2513204
• DOI: http://doi.org/10.12790/ahm.20.0055

Abstract

Lymphedema is a chronic and progressive disease that affects many of the patients who underwent cancer ablative surgery and decreases the quality of life of them. Surgical management including lymphovenous shunting and vascularized lymph node transfer become popular in the field of microsurgery. For the better outcome of microsurgical approach to lymphedema, understanding of multiple image modalities is essential. Also, understanding other conservative management tools is crucial for setting reasonable algorism for lymphedema management.

Keyword

Lymphedema; Lymphovenous shunting; Lymph node transfer; Magnetic resonance lymphangiography

Figure

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  Fig. 1. Lymphoscintigraphy of left leg lymphedema. Dermal backflow is shown in the entire left leg. Written informed consent was obtained for publication of this study and accompanying images.

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  Fig. 2. Magnetic resonance lymphoscintigraphy of the upper arm with lymphedema. Dermal backflow and the tortuous lymphatic vessel (arrows) were found in the fat layer. Written informed consent was obtained for publication of this study and accompanying images.

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  Fig. 3. Indocyanine green lymphography of hand dorsum. There is a dermal backflow. Written informed consent was obtained for publication of this study and accompanying images.

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  Fig. 4. Duplex color Doppler visualizes cutaneous vein (red arrow) and lymphatic vessel located in deeper layer (green arrow). Written informed consent was obtained for publication of this study and accompanying images.

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  Fig. 5. Sixty four-years-old female suffered from the left leg for 15 years after ovarian cancer surgery. (A) The patient showed severe swelling of the thigh even after compressive decongestive therapy. (B) Magnetic resonance lymphangiography showed a good functioning lymphatic vessel at the lower leg. (C, D) Three lymphovenous anastomoses were done, and there was good lymphatic flow in indocyanine green lymphangiography intraoperatively by an embedded infrared camera in microscopy. (E) Reduction of thigh circumference was maintained after 6 months of lymphovenous shunting surgery. Written informed consent was obtained for publication of this study and accompanying images.

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  Fig. 6. Two lymphatic vessels were found in the fat layer after making a skin incision. Fluorescent dye was injected before making a skin incision. These deep lymphatic vessels were sized 0.3 mm and 0.5 mm. Written informed consent was obtained for publication of this study and accompanying images.

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  Fig. 7. Three lymphovenous shunting were done through a 1-cm skin incision on the ankle. Veins (red arrows) showed a clear lumen after shunting due to good lymphatic flow to the proximal vein from lymphatic vessels (green arrows). Written informed consent was obtained for publication of this study and accompanying images.

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  Fig. 8. One vascular lymph node and skin flap, including lymphatic vessel in the deep fat layer, was harvested from the groin. Written informed consent was obtained for publication of this study and accompanying images. Written informed consent was obtained for publication of this study and accompanying images.

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