Lymphedema Surgical Treatment – Current And Future

VASCULARIZED LYMPH NODE TRANSFER (VLNT)

Vascularized Lymph Node Transfers (VLNT) have been shown to be an effective method for the treatment of the arm. Lymph nodes are taken from the donor area with their supporting blood vessels and moved to a new location in the axilla (armpit). Dr. Granzow then uses specialized microsurgical techniques to reconnect the blood vessels to new vessels, providing vital support to the transferred lymph nodes while they heal in the new area.

The transferred lymph nodes then serve as a filter or conduit to remove the excess lymphatic fluid from the arm or leg and return it to the body’s natural circulation.

This method of lymph node transfer can be performed independently or together with a DIEP flap breast reconstruction. The combined procedure allows for both the simultaneous treatment of the arm and the creation of a breast in one surgery. The DIEP flap reconstruction provides the opportunity for a beautiful and natural-appearing reconstructed breast combined with contouring of the abdomen (similar to a tummy tuck). The lymph node transfer portion of the surgery removes the excess lymphatic fluid to return form, softness, and function to the arm.

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LYMPHATICOVENOUS ANASTOMOSIS (LVA)

Lymphaticovenous anastomosis (LVA) involves the use of superfine microsurgery to join lymphatic channels in the affected area directly to nearby veins. The lymphatics are quite small, typically approximately 0.1 mm to 0.3 mm in diameter. The procedure employs specialized techniques and superfine surgical sutures sewn with the aid of an adapted high power microscope.

The procedure can be an effective and long-term solution for extremities. Patients must have excess fluid in the arm or leg with pitting issues to be candidates for this procedure. After the procedure, many patients significantly decrease or eliminate the use of their compression garments.

LVA is the least invasive of the modern procedures. Patients have the option of returning home the day of their procedure.

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SUCTION-ASSISTED PROTEIN LIPECTOMY (SAPL)

SAPL has been found to be successful in treating excess fat and protein-rich solids found in advanced stages of Lymphedema. It must be emphasized that the SAPL technique is NOT the standard cosmetic liposuction technique. The procedure must be performed using specific parameters, methods, and protocols, many of which have been initially developed and studied by Dr. Hakan Brorson in Malmo, Sweden. Specific training in this method is required, of which Dr. Granzow has taken in Sweden with Dr. Brorson. Patients are candidates if the swelling in the limb is due to deposition of fat, protein, and fibrotic tissue with non-pitting edema.

Our published studies and studies throughout the medical literature indicate a long-term and reproducible reduction in the size of the affected arm or leg and a tremendous decrease in the rate of cellulitis or infections in the affected limb.

This procedure does not appear to damage lymphatics.  In fact, it is Dr. Granzow’s experience lymphatic drainage appears to improve following the procedure and care of the affected arm or leg becomes easier.  Published studies in the medical literature have specifically looked at the lymphatic system before and after SAPL, and no decrease in function has been found.

Volume reduction is maintained with the use of compression garments after surgery. Dr. Granzow has pioneered a staged set of procedures in which an additional surgery, such as a VLNT, may be used at a later time to decrease the amount of compression required. This is described further on our SAPL page.

Again, specialized training of the surgeon specifically in this technique is critical. We do not recommend liposuction of affected limbs by surgeons who have not been specifically trained in the SAPL technique.

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