Surgical debulking, lymphatico venous anastomosis, vascularised lymph node transfer in lower limb lymphoedema

Abstract

Lymphoedema is a chronic debilitating disease of the lymphatic system that occurs due to either abnormal development or damage of the lymphatics resulting from cancer or infection. The optimal treatment of lymphoedema is still elusive. Management is tailored according to clinical features, investigations and expectations of each patient. Lymphoedema patients should undergo a trial of conservative management with compression therapy, manual lymphatic drainage and external sequential compression devices. Early lymphoedema is treated by lymphovascular anastomosis, where the lymph vessels are connected to the subdermal veins by supermicrosurgery. In late cases when the limb is fibrotic, vascularised lymph node transfers are done, where lymph nodes are transferred from a healthy area to the affected area. In advanced cases, when the limb is fibrotic with cutaneous folds and skin changes, surgical debulking is done. In lymphoedema, along with accumulation of lymphatic tissue, there is also fat deposition, which can be removed by liposuction. One should be conversant with all treatment modalities to provide the lymphoedema patient with optimal care.