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What options are available for treating lymphedema?
Lymphaticovenular anastomosis (LVA) is a bypass procedure that redirects excess lymphatic fluid into the venous circulation within the arm or leg. Small, superficial incisions are made on the extremity, and a powerful surgical microscope is used to identify tiny lymphatic vessels beneath the skin. Once located, these lymphatic vessels can be connected to nearby small blood vessels (venules). As many lymphaticovenular connections as possible are created to facilitate shunting of fluid. This procedure is often performed on an outpatient basis.
In situations when lymph node basins do not function, such as after lymph node dissection or radiation therapy, vascularized lymph node transfer (VLNT) can promote lymphatic drainage. Donor lymph nodes can be harvested from a variety of locations such as the lower abdomen and neck. This procedure typically uses microsurgery techniques to transfer lymph nodes and fatty tissue with their blood supply. This procedure typically requires hospitalization for a few days.
Women who are seeking simultaneous breast reconstruction and treatment of arm lymphedema due to breast cancer may be candidates for autologous breast reconstruction using lower abdominal flaps (such as DIEP flap) with attached lymph nodes.
Ablative procedures aim to remove excess skin and soft tissue to decrease bulk and facilitate hygiene. These operations are usually reserved for patients with advanced-stage lymphedema with significant fibrosis and fatty infiltration. Removal of redundant skin with this technique may require more than one surgery. More recently, liposuction has been successfully used to treat patients with advanced lymphedema with excess fat who are not candidates for lymphaticovenular anastomosis or lymph node transfer. It is important to recognize that patients must be committed to lifelong compression garments to maintain the effects of liposuction.
Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.