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Principles of Patient Selection for Surgical Management of Lymphedema

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Lymphedema

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Abstract

Advances in lymphatic imaging have greatly improved the surgeon’s ability to properly select patients and apply the most appropriate surgical intervention to the specific diagnosis. Physiologic procedures are commonly used to treat earlier forms of lymphedema in a fluid-dominant state, while liposuction may be indicated in the more advanced fat-dominant state. Four components of the work-up include evaluation of lymphatic function, fibrofatty proliferation, immunologic function, and the venous system. Indocyanine green lymphangiography and magnetic resonance lymphangiography allow the surgeon to determine the patency and function of lymphatic collectors which impact decision-making for vascularized lymph node transfer and lymphaticovenular anastomosis. Magnetic resonance angiography can provide information about the fluid-to-fat ratio as well as the status of the venous system that is fundamental to assessing any swollen limb. Prospective study with newer imaging technologies will further optimize selection criteria and outcomes.

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Author information

Authors and Affiliations

  1. Division of Plastic & Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Joseph H. Dayan MD

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  1. Joseph H. Dayan MD
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Correspondence to Joseph H. Dayan MD .

Editor information

Editors and Affiliations

  1. Center for the Lymphedema and Vascular Malformations, Division of Vascular Surgery, Department of Surgery, George Washington University, Washington, DC, USA

    Byung-Boong Lee

  2. Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, California, USA

    Stanley G. Rockson

  3. La Jolla, California, USA

    John Bergan

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© 2018 Springer International Publishing AG

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Dayan, J.H. (2018). Principles of Patient Selection for Surgical Management of Lymphedema. In: Lee, BB., Rockson, S., Bergan, J. (eds) Lymphedema. Springer, Cham. https://doi.org/10.1007/978-3-319-52423-8_46

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  • DOI: https://doi.org/10.1007/978-3-319-52423-8_46

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52421-4

  • Online ISBN: 978-3-319-52423-8

  • eBook Packages: MedicineMedicine (R0)

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