Surgical Treatment of Lymphedema
Lymphedema is a chronic condition characterized by fluid accumulation in the arms or legs, often developing after cancer treatments or due to congenital causes. Lymph node removal or radiation therapy, particularly during treatment for breast cancer, gynecological cancers, or melanoma, can damage the lymphatic drainage pathways. While this condition can be managed with physical therapy and pressure applications in the early stages, it can cause permanent tissue changes in advanced stages and may require surgical treatment.
There are two basic approaches to the surgical treatment of lymphedema: volume-reducing excision techniques and microsurgical procedures aimed at restoring lymphatic circulation. Excision methods aim to reduce leg or arm volume in advanced-stage patients by removing edematous and fibrotic tissue. Vacuum-assisted techniques, such as liposuction, or direct excision of subcutaneous fibrosis fall into this category.
The goal of microsurgical techniques is to reestablish impaired lymphatic circulation. One of the most commonly performed procedures is lymph node transfer. In this procedure, healthy lymph nodes are taken from another part of the body (e.g., groin, neck, supraclavicular area, intra-abdominal area) and transplanted with their vessels to the lymphedema area. Microsurgery reconnects the vessels to these nodes, aiming to function in the new area. This reestablishes lymphatic drainage.
Another important method is lymphatic bypass surgery. In this technique, blocked lymphatic channels are directly connected to small veins (lymphovenous anastomosis) using microsurgical techniques. This diverts lymphatic fluid from the lymphatic system to the venous system, reducing edema. These procedures are generally more effective in early and mid-stage lymphedema.
Lymphedema surgery should be planned individually. The appropriate procedure is determined by evaluating the disease stage, tissue condition, past treatments, and overall health. Regular follow-up after surgery and continued supportive treatments such as compression and physiotherapy are crucial for the success of the treatment. In appropriate patients, microsurgical procedures can significantly improve quality of life.