Skip to main content

Principles of Patient Selection for Surgical Management of Lymphedema

  • Chapter
  • First Online:
Lymphedema
  • 2790 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Highlighted References

  1. Yamamoto T, Yamamoto N, Doi K, Oshima A, Yoshimatsu H, Todokoro T, Ogata F, Mihara M, Narushima M, Iida T, Koshima I. Indocyanine green-enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow patterns. Plast Reconstr Surg. 2011;128(4):941–7.

    Article  CAS  PubMed  Google Scholar 

  2. Neligan PC, Kung TA, Maki JH. MR lymphangiography in the treatment of lymphedema. J Surg Oncol. 2016;115(1):18–22.

    Article  PubMed  Google Scholar 

  3. Loh CY, Wu JC, Nguyen A, Dayan J, Smith M, Masia J, Chang D, Koshima I, Cheng MH. The 5th world symposium for lymphedema surgery-recent updates in lymphedema surgery and setting up of a global knowledge exchange platform. J Surg Oncol. 2016;115(1):6–12.

    Article  PubMed  Google Scholar 

  4. Dayan JH, Dayan E, Smith ML. Reverse lymphatic mapping: a new technique for maximizing safety in vascularized lymph node transfer. Plast Reconstr Surg. 2015;135(1):277–85.

    Article  CAS  PubMed  Google Scholar 

  5. Yamamoto T, Yamashita M, Furuya M, Hayashi A. Lymph preserving lipectomy under indocyanine green lymphography navigation. J Plast Reconstr Aesthet Surg. 2015;68(1):136–7.

    Article  PubMed  Google Scholar 

References

  1. Rockson SG. Inflammatory cytokines and the lymphatic endothelium. Lymphat Res Biol. 2014;12(3):123.

    Article  PubMed  Google Scholar 

  2. Cuzzone DA, Weitman ES, Albano NJ, Ghanta S, Savetsky IL, Gardenier JC, Joseph WJ, Torrisi JS, Bromberg JF, Olszewski WL, Rockson SG, Mehrara BJ. IL-6 regulates adipose deposition and homeostasis in lymphedema. Am J Physiol Heart Circ Physiol. 2014;306(10):H1426–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Mihara M, Hara H, Araki J, Kikuchi K, Narushima M, Yamamoto T, Iida T, Yoshimatsu H, Murai N, Mitsui K, Okitsu T, Koshima I. Indocyanine green (ICG) lymphography is superior to lymphoscintigraphy for diagnostic imaging of early lymphedema of the upper limbs. PLoS One. 2012;7(6):e38182.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Mehrara BJ, Greene AK. Lymphedema and obesity: is there a link? Plast Reconstr Surg. 2014;134(1):154e–60e.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Campisi CC, Ryan M, Boccardo F, Campisi C. A single-site technique of multiple lymphatic-venous anastomoses for the treatment of peripheral lymphedema: long-term clinical outcome. J Reconstr Microsurg. 2016;32(1):42–9.

    PubMed  Google Scholar 

  6. Mihara M, Hara H, Hayashi Y, et al. Greene A, editor. Pathological steps of Cancer-related lymphedema: histological changes in the collecting lymphatic vessels after lymphadenectomy. PLoS One. 2012;7(7):e41126.

    Google Scholar 

  7. Brorson H. Complete reduction of arm lymphedema following breast Cancer - a Prospective twenty-one Years’ study. Plast Reconstr Surg. 2015;136(4 Suppl):134–5.

    Article  PubMed  Google Scholar 

  8. Brorson H. Liposuction normalizes lymphedema induced adipose tissue hypertrophy in elephantiasis of the leg - a Prospective study with a ten-year follow-up. Plast Reconstr Surg. 2015;136(4 Suppl):133–4.

    Article  PubMed  Google Scholar 

  9. Dayan JH, Kleyman S, Verma R, Mehrara B. Indocynanine green lymphangiography findings in patients who do not meet clinical diagnostic criteria for lymphedema. Kona, Hawaii: Presented at the American Society for Reconstructive Microsurgery; 2017.

    Google Scholar 

  10. Yamamoto T, Yamamoto N, Yamashita M, Furuya M, Hayashi A, Koshima I. Efferent lymphatic vessel anastomosis: Supermicrosurgical efferent lymphatic vessel-to-venous anastomosis for the prophylactic treatment of subclinical lymphedema. Ann Plast Surg. 2016;76(4):424–7.

    Article  CAS  PubMed  Google Scholar 

  11. Smith ML, Molina BJ, Dayan E, Saint-Victor DS, Kim JN, Kahn ES, Kagen A, Dayan JH. Heterotopic vascularized lymph node transfer to the medial calf without a skin paddle for restoration of lymphatic function: proof of concept. J Surg Oncol. 2016;115(1):90–5.

    Article  PubMed  Google Scholar 

  12. Dayan JH, Dayan E, Kagen A, Cheng MH, Sultan M, Samson W, Smith ML. The use of magnetic resonance angiography in vascularized groin lymph node transfer: an anatomic study. J Reconstr Microsurg. 2014;30(1):41–5.

    Article  PubMed  Google Scholar 

  13. Hager ES, Yuo T, Tahara R, Dillavou E, Al-Khoury G, Marone L, Makaroun M, Chaer RA. Outcomes of endovascular intervention for May-Thurner syndrome. J Vasc Surg Venous Lymphat Disord. 2013;1(3):270–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joseph H. Dayan MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

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

Download citation

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

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-52421-4

  • Online ISBN: 978-3-319-52423-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics