Surgical treatment of primary and secondary lymphedema
- Babak Mehrara, MD
Babak Mehrara, MD
- Associate Professor of Surgery
- Cornell Weill Medical Center
- Section Editors
- Russell S Berman, MD
Russell S Berman, MD
- Section Editor — Skin and Soft Tissue Surgery
- Chief of Surgical Oncology
- New York University Langone Medical Center
- Charles E Butler, MD, FACS
Charles E Butler, MD, FACS
- Section Editor — Plastic and Reconstructive Surgery
- The University of Texas, MD Anderson Cancer Center
Operative management of primary and secondary lymphedema is typically reserved for localized primary malformations, failed medical management, or recurrent cellulitis in affected extremities. There is no consensus regarding the role of surgery, the optimal surgical approach, or the timing of an operative procedure for extremity lymphedema.
The indications, preoperative evaluation, and operative management of primary and secondary lymphedema will be reviewed here. Other characteristics of lymphedema, including etiology, diagnosis, and clinical manifestations, are discussed elsewhere. (See "Clinical features and diagnosis of peripheral lymphedema" and "Clinical staging and conservative management of peripheral lymphedema" and "Pathophysiology and etiology of edema in children" and "Clinical manifestations and diagnosis of edema in adults".)
INDICATIONS FOR SURGERY
Nonoperative measures, including compressive garments and decongestive therapy, are the initial approach for management of lymphedema, as discussed elsewhere. (See "Clinical staging and conservative management of peripheral lymphedema", section on 'Overview of management'.)
The indications for operative management of primary and secondary lymphedema include [1-6]:
●Localized primary lesions (including microcystic and macroscopic lymphatic malformations)
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- INDICATIONS FOR SURGERY
- PREOPERATIVE EVALUATION
- OPERATIVE MANAGEMENT
- Physiological techniques
- - Lymphatic bypass procedures
- Reductive techniques
- - Direct excision
- - Liposuction
- - Outcomes for reductive techniques
- Direct excision outcomes
- Liposuction outcomes
- POSTOPERATIVE MANAGEMENT
- FUTURE DIRECTIONS AND EXPERIMENTAL PROCEDURES
- SUMMARY AND RECOMMENDATIONS