Staged surgical treatment of extremity lymphedema with dual gastroepiploic vascularized lymph node transfers followed by suction‐assisted lipectomy—A prospective study

• Published in: Journal of surgical oncology 2018-05, Vol.117 (6), p.1148-1156
• Main Authors: Agko, Mouchammed, Ciudad, Pedro, Chen, Hung‐Chi
• Format: Article
• Language: English
• Subjects: Abdomen - surgery; Adult; Aged; Cancer surgery; Compression therapy; Extremities - surgery; Female; Follow-Up Studies; Gastroepiploic Artery; Humans; Lipectomy - methods; Lymph Nodes - blood supply; Lymph Nodes - transplantation; Lymphatic system; Lymphedema; Lymphedema - surgery; lymphedema treatment; Middle Aged; Postoperative Complications - surgery; Prognosis; Prospective Studies; staged combined surgical treatment; Suction; suction assisted lipectomy; vascularized lymph node transfer
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24969

Background Both physiologic and excisional procedures have been described for the treatment of lymphedema. However, there exist few reports that combine these procedures. The objective of this study was to evaluate the effectiveness of combining vascularized lymph node transfer (VLNT) with suction‐assisted lipectomy (SAL) in a staged manner for the treatment of extremity lymphedema. Methods Patients with unilateral late stage II lymphedema (International Society of Lymphology), who consented to staged surgical treatment, were evaluated prospectively. Between 2014 and 2015, 12 female patients with upper (n = 6) or lower (n = 6) extremity lymphedema completed the treatment protocol. Primary outcomes evaluated included limb size and number of infectious episodes. In addition, compression garment usage was analyzed. Results The overall circumference reduction rate was on average 37.9% after VLNT and increased to 96.4% after SAL. While all patients had experienced at least one infectious episode prior to surgical treatment, only one patient did so after VLNT and none after SAL. All patients were able to eventually discontinue compression therapy. Conclusion VLNT followed by SAL can allow patients with late Stage II lymphedema achieve near normal limb size and eradication of infectious episodes. At follow‐up, these desirable outcomes were maintained well after discontinuation of compression therapy.