Novel combined surgical treatment for chronic upper extremity lymphedema patients : simultaneous lymph node transfer and liposuction

Abstract

BACKGROUND: Upper limb lymphedema is a common problem after axillary lymph node dissection. Lymphatic drainage can be improved by microvascular lymph node transfer, whereas liposuction can be used to reduce arm volume and excess of adipose tissue. We present the results of chronic lymphedema patients who have undergone lymph node transfer and liposuction simultaneously in one operation and compare the results to patients who have undergone lymph node transfer without liposuction. METHODS: During May 2007 to February 2015, 20 postmastectomy patients and one Hodgkin’s lymphoma patient presenting with chronic non-pitting lymphedema (age between 37-74 years, average 56.7 years) were operated using the combined technique and 27 postmastectomy patients presenting with early stage lymphedema (age between 31 to 68 years, average age 50.2 years) were operated using only the lymph node transfer. Changes in clinical parameters, arm volume, lymphoscintigraphy and compression garment usage were compared. The study was retrospective observational study. RESULTS: In the combined technique group the average arm volume excess decreased postoperatively 87.7% and in 7/10 patients the edema volume did not increase even without compression. 17/21 patients were able to reduce the use of compression garment. Lymphoscintigraphy results were improved in 12/15 patients and the improvement was significantly greater than in the lymph node transfer group. The number of erysipelas infections was decreased in 7/10 patients and the decrease was significantly greater than in the lymph node transfer group. In the lymph node transfer group the average excess volume decreased postoperatively 27.5%. 14/27 patients were able to reduce the use of compression garment. Lymphoscintigraphy results were improved in 8/19 patients, the number of erysipelas infections was decreased in 1/3 patients. CONCLUSIONS: Liposuction can safely be performed with lymph node transfer in one operation to achieve optimal results in patients with chronic lymphedema. The combined technique provides immediate volume reduction and further regenerative effects on the lymphatic circulation. The significantly greater reduction in lymphoscintigraphy values and erysipelas infections suggests that the combined technique might be better for late stage lymphedema patients than lymph node transfer alone.