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Improving Surgical Management of Lymphedema

Improving Surgical Management of Lymphedema

When patients experience lymphedema, the most common treatment approach is the conservative route, reducing the swelling and discomfort with compression and massage therapy and/or diet modification. But some patients find greater relief with surgical management, which may include tissue removal, liposuction, lymph node transfer or the lesser-known lymphovenous bypass.

Five years ago, few were performing lymphovenous bypasses. Although the concept had existed for decades, the technology had not yet caught up to the procedure, which involves super-microscopic techniques and equipment. The procedure is now an outpatient one that reroutes the lymphatic system directly to the venous system, bypassing the damaged nodes and connecting the lymphatic channels directly into tiny, almost microscopic veins. It can significantly reduce the swelling and, in some cases, return the limb to normal function.

“We’re excited about this technique because it can have the potential to help a lot of people with not a lot of downside for the patient,” says Damon Cooney, assistant professor of plastic and reconstructive surgery.

Another microvascular option for patients with lymphedema is lymph node transfer, where surgeons transplant a group of lymph nodes, along with their blood supply, from a healthy part of the body to the affected area. “For years, patients had no good option other than therapy,” says Justin Sacks, director of oncological reconstruction. “Now we have new techniques that address the physiology of the patient, literally rewiring the lymphatic system.”

While the department is currently performing several lymphovenous bypasses per month, faculty members are also conducting research to find out how to maximize its success rate, eventually hoping to expand the pool of candidates who could benefit.

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