Lymphedema Surgery and Specialized Microsurgery
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Lymphedema Surgical Treatment Options
Several effective surgical treatments exist for lymphedema. Some, like vascularized lymph node transfers, are relatively new techniques. Others, such as lymphaticovenous anastomoses, have been described previously and more recently modified and improved with better results.
These specialized techniques are performed by only a small handful of highly skilled microsurgeons worldwide. Dr. Granzow is a pioneer in this field and continually works with colleagues from around the world to further improve these surgeries.
Vascularized Lymph Node Transfer
Vascularized lymph node transfers can be an effective method for the treatment of lymphedema of the arm and upper extremity. Lymph nodes are harvested from the groin area with their supporting artery and vein and moved to the axilla (armpit). Dr. Granzow then uses specialized microsurgical techniques to reconnect the artery and vein to new blood vessels in the axilla to provide vital support to the lymph nodes while they develop their own blood supply over the first few weeks after surgery.
The newly transferred lymph nodes then serve as a conduit or filter to remove the excess lymphatic fluid from the arm and return it to the body's natural circulation.
This technique of lymph node transfer usually is performed together with a DIEP flap breast reconstruction. This allows for both the simultaneous treatment of the arm lymphedema and the creation of a breast in one surgery. The DIEP flap provides the opportunity for a beautiful and natural appearing breast reconstruction combined with the abdominal contouring very similar to a tummy tuck. The lymph node transfer removes the excess lymphatic fluid to return form and function to the arm.
In selected cases, the lymph nodes may be transferred as a group with their supporting artery and vein but without the associated abdominal tissue for breast reconstruction.
Lymphaticovenous Anastomosis
Lymphaticovenous anastomosis describes the use of supermicrosurgery to connect the affected lymphatic channels directly to tiny veins located nearby. The lymphatics are tiny, typically approximately 0.1 mm to 0.3 mm in diameter. The procedure requires the use of specialized techniques with superfine surgical suture and an adapted high power microscope.
The procedure can be an effective and long-term solution for extremity lymphedema, and most patients in our experience have results which range from a moderate improvement to an almost complete resolution of the problem.
Dr. Granzow adapted his surgical technique from the father of microsurgery, Dr. Isao Koshima. He studied with Dr. Koshima in Japan and still maintains close professional contact with him. Dr. Koshima has pioneered the field of supermicrosurgery and applied his methods to the lymphaticovenous anastomosis procedure. Current results show much greater success rates than were reported previously by other surgeons who attempted to perform the the lymphatocovenous anastomosis technique.
Dr.Jay Granzow and Dr. Isao Koshima performing lymphaticovenous anastomoses in Japan
Patient Selection
Both microvascular lymph nodes transfers and lymphaticovenous anastomoses are most effective in patients whose extremity circumference reduces significantly with compression wrapping, indicating most of the edema is fluid. Patients who do not respond to compression are less likely to fare well with lymphaticovenous anastomoses as a greater amount of their increased extremity volume consists of fibrotic tissue, protein or fat.
Prior to any lymphedema surgery, patients should have been treated by an occupational or physical therapist for initial conservative treatment of their lymphedema. The therapist preferably should have training and experience specifically with lymphedema patients. Complete decompression therapy (CDT), manual lymphatic drainage (MLD) and compression bandaging are all helpful components of conservative lymphedema treatment.
Specialized Liposuction for Advanced Lymphedema of the Extremity
Patients who have limbs which no longer adequately respond to standard lymphatic compression therapy may be candidates for liposuction specifically adapted to treat this advanced condition. This technique has been pioneered by Dr. Hakan Brorson in Malmo, Sweden.
The liposuction appears to be an effective method of reducing the size and stiffness of the affected extremity. However, a significant limitation of the technique is that currently the procedure must be followed by lifelong use of compression garments to prevent a recurrence of the lymphedema.
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