SURGICAL OPTIONS

Lymphovenous anastomosis

It consists of diverting lymphatic vessels to superficial veins to facilitate the return of lymph to the blood. This requires active lymphatic channels. This is achieved by supramicrosurgery techniques, suturing vessels less than 0.5 mm. It is indicated in the prophylaxis and early treatment of lymphedema. It is necessary that there are lymphatic vessels of sufficient size and that they are healthy.

 

Lymph node transplant

It consists of taking lymph nodes from an area in which they are "left over" and transporting them to the area where they were removed. The lymph nodes, fat, and skin are transplanted with the arteries and veins that nourish them. It is a highly specialized microsurgery technique that must be performed by experienced professionals. It is especially indicated in the case of retractable scars and in the mixed reconstruction of the breast and lymphatic system.

 

Specific technique of selective lymphatic liposuction

To remove fibrosis and deposited fat, when the lymph has been extravasated for a long time. It is indicated in very long-lived lymphedemas, where these deposits exist. These techniques, independently or in combination, manage to improve the quality of life of patients with lymphedema.

 

Can prophylaxis be performed?

The aim is to minimize the likelihood of lymphedema after performing an axillary or inguinal lymphadenectomy or selective sentinel node biopsies (BSGC). In the case of BSGCs, indocyanine green staining of the extremity ganglia will be performed at the same time. If the sentinel node to be removed is also a sentinel node of the limb, an ALV is performed. In the case of lymphadenectomies, one or more ALVs will be performed in the same surgical field, thus diverting the lymph to the venous system. Prophylaxis can also be performed in the first few months after surgery and once the helpful treatment has been completed, if any.

Surgical treatment of lymphedema can be divided into two groups: reconstructive or physiological techniques that focus on the functional restitution of the damaged lymphatic system and ablative or reducing techniques, which aim at reducing volume by resecting hypertrophied skin-adipose tissue.

 

It is important to remember that, according to studies previously conducted by qualified professionals, it will be necessary to assess which patients can access surgical treatment and which patients only need conservative treatment with physiotherapy.

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