title: An effective system of surgical treatment of lymphedema.
abstract: BACKGROUND
  Effective surgical treatments for lymphedema now can address the fluid and solid phases of the disease process. Microsurgical procedures, including lymphaticovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT), target the fluid component that predominates at earlier stages of the disease. Suction-assisted protein lipectomy (SAPL) addresses the solid component that typically presents later as chronic, nonpitting lymphedema of an extremity. We assess the outcomes of patients who underwent selective application of these three surgical procedures as part of an effective system to treat lymphedema.
  
  
  METHODS
  This is a retrospective chart review of patients with lymphedema who underwent complete decongestive therapy followed by surgical treatment with SAPL, LVA, or VLNT. The primary outcomes measured were postoperative volume reduction (SAPL), daily requirement for compression garments and lymphedema therapy (VLNT and LVA), and the incidence of severe cellulitis.
  
  
  RESULTS
  Twenty-six patients were included in the study, of which 10 underwent SAPL and 16 underwent LVA or VLNT. The average reduction of excess volume by SAPL was 3,212 mL in legs and 943 mL in arms, or a volume reduction of 87 and 111 %, respectively, when compared with the unaffected, opposite sides. Microsurgical procedures (VLNT and LVA) significantly reduced the need for both compression garment use (p = 0.003) and lymphedema therapy (p < 0.0001). The overall rate of cellulitis decreased from 58 % before surgery to 15 % after surgery (p < 0.0001).
  
  
  CONCLUSIONS
  When applied appropriately to properly selected patients, surgical procedures used in the treatment of lymphedema are effective and safe.
authors: UCLA Division of Plastic Surgery, Harbor-UCLA Medical Center and UCLA David Geffen School of Medicine, Los Angeles, CA, USA, drjay@plasticsurgery.la.
authors: Jay W
authors: JW
authors: Granzow
authors: Julie M
authors: JM
authors: Soderberg
authors: Amy H
authors: AH
authors: Kaji
authors: Christine
authors: C
authors: Dauphine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000150:complications*; D006801:Humans; D015187:Lipectomy; D008197:Lymph Node Excision; D042601:Lymphatic Vessels / Q000473:pathology / Q000601:surgery*; D008209:Lymphedema / Q000209:etiology / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult