How is lymphaticovenous bypass/anastomosis (LVB/LVA) performed?
LVB can be performed under local, regional, or general anaesthesia, commonly in isolation as day surgery or in combination with other techniques such as excisional procedures or VLNT. Once you are lying comfortably, the surgeon will inject a safe, fluorescent dye into the distal part of the affected area and use a sophisticated device to visualize the superficial lymphatic channels and where they are blocked. Another device may also be used to find the accompanying veins. At the points where the lymphatic channels and veins overlap or run beside each other, a small 2-2.5cm incision will be made to identify the lymphatic channels and the veins. Utilizing a high-powered microscope and superfine instruments and sutures, these will then be sutured together to form the LVB. Sometimes, multiple LVBs can be performed at a single site. The affected area will then be wrapped or placed in a compression garment. The incision will then be closed meticulously. The result from LVBs can be felt almost immediately. In general, the more LVBs done on the affected area, the better the result.
How is Vascularized Lymph Node Transfer (VLNT) performed?
VLNT involves the harvest of lymph nodes with a known blood supply from an area with excess nodes and transferring them to the affected area to release scar tissue and stimulate new lymphatic formation. It is usually performed under general anaesthesia. There are multiple sites where lymph nodes can be harvested from, including the neck, groin and omentum (intra-abdominally). The risk of causing donor site lymphedema is extremely low. The lymph nodes can be transferred without having to reattach the blood supply (pedicled flap) or as a free flap, where the blood supply has to be reattached at the recipient site. Post-operatively, there may be drains, and a 2- to 3-day hospital stay is usually required. As the VLNT requires some time to stimulate the formation of new channels, the final results are usually seen only at about one-year post-surgery.
VLNT can be combined with excisional procedures and LVB. Your surgeon will discuss the recommended options for you.
How is excisional lymphedema surgery performed?
Excisional techniques for lymphedema include minimally invasive methods such as liposuction, or techniques where the lymphatic tissue and involved skin is directly excised. In some cases, the excised area may have to be skin-grafted (Charles Procedure). Excisional lymphedema surgery is usually recommended in cases of ISL stage 3 lymphedema, or where there is a large amount of fatty tissue, fibrosis, and skin changes. It can also be performed in addition to physiological procedures like LVB and VLNT, to help reduce the lymphatic load whilst the physiological procedures take their time to work. Your surgeon will assess the severity of your lymphedema and recommend the appropriate treatment.
Can lymphedema surgery techniques be combined?
Yes, they can. Whilst excisional techniques address the fibrotic and fatty tissue that are caused by lymphedema, the physiological techniques can address the heart of the problem in the lymphatic channels. When combined, they can be work synergistically.
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