title: Operative treatment of peripheral lymphedema: a systematic meta-analysis of the efficacy and safety of lymphovenous microsurgery and tissue transplantation.
abstract: BACKGROUND
  The purpose of this study was to quantify the efficacy and safety of microsurgery for lymphedema through a systematic meta-analysis, which has not been described before.
  
  
  METHODS
  A literature search was conducted to identify all articles involving microsurgical treatment of lymphedema. Studies meeting criteria for inclusion were rated on methodologic quality based on the American Society of Plastic Surgeons levels of evidence. Demographic information, cause of lymphedema, and surgical technique were recorded. Quantitative change in lymphedema and perioperative complications were noted.
  
  
  RESULTS
  Twenty-seven studies were included, with 24 offering level IV evidence and three offering level III evidence. Lymphovenous shunt procedures were performed in 22 studies and lymph node transplantation was performed in five. Excess circumference was reduced by 48.8 ± 6.0 percent, and absolute circumference was reduced by 3.31 ± 0.73 cm. Studies reporting change in volume demonstrated reduction in excess volume by 56.6 ± 9.1 percent, and absolute volume was reduced by 23.6 ± 2.1 percent. The incidence of no improvement in lymphedema postoperatively was 11.8 percent, and 91.2 percent of patients reported subjective improvement. Approximately 64.8 percent of patients discontinued compression garments at follow-up. Complications included operative-site infection (4.7 percent), lymphorrhea (7.7 percent), reexploration for flap congestion (2.7 percent), and additional procedures (22.6 percent).
  
  
  CONCLUSIONS
  Operative interventions for peripheral lymphedema appear to provide consistent quantitative improvements postoperatively, with a relatively wide safety margin. Lymph node transplantation may provide better outcomes compared with lymphovenous shunt, but well-designed head-to-head comparisons are needed to evaluate this further.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Philadelphia, Pa. From the Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania; the Division of Plastic Surgery, Hospital of the University of Pennsylvania; and the Division of Plastic Surgery, University of Pennsylvania Health Systems.
authors.forename: Marten N
authors.initials: MN
authors.lastname: Basta
authors.forename: Lin Lin
authors.initials: LL
authors.lastname: Gao
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
mesh_terms: D005121:Extremities; D006801:Humans; D008198:Lymph Nodes / Q000637:transplantation; D008208:Lymphatic System / Q000601:surgery; D008209:Lymphedema / Q000503:physiopathology / Q000601:surgery*; D008866:Microsurgery; D011182:Postoperative Care