Lymphedema is a very difficult condition to treat and many patients are told that they must suffer with lifelong compression dressings, pain, and swelling. Anyone suffering from arm lymphedema from postmastectomy lymph node dissection and/or radation, or lymphedema of the legs from injury or pelvic lymph node removal/radiation understands that this is not an acceptable option. Very often, patients are young and active and maybe otherwise healthy and are seeking more long-term solutions to improve their quality of life.
Lymphatic venous anastomosis has been a treatment option for over 30 years. It has waxed and waned in terms of treatment efficacy and therein lies the controversy. Only more recently, with the advent of super microsurgical techniques and instruments, have higher rates of success with vessels and lymphatics at 0.5 mm and less, become the norm. There have been significantly improved outcomes since the early days of microsurgery. Dr. Isao Koshima in Tokyo, Japan has been pushing the envelope for decades with advanced super microsurgery techniques. He is a pioneer in super microsurgery and has some of the most extensive experience and long-term follow-up of lymphatic patients in the world.
Lymphatico Venous Anastomsis as seen under the Operating Microscope
(Performed by Dr. Charles K. Lee at St.Mary’s Medical Center, San Francisco, CA, October 2012)
I was fortunate to learn from Dr. Isao Koshima directly on his techniques and share knowledge and experience with colleagues from around the world about the latest treatments for lymphedema. I am fortunate to have both Drs. Koshima and Dr. David Chang at M.D. Anderson Cancer Center as my mentors in this regard.
With Drs. David Chang (Left) and Dr. Isao Koshima (Center)
at Tokyo University, Tokyo, Japan, September 2012.
In combination with lymph node transplantation as a free tissue transfer from the groin, abdomen, axilla, shoulder, or neck (large lymph node basins) with additional lymphatic venous anastomosis, this two-pronged approach to addressing improved lymphatic flow has likely made the greatest advances in the treatment for lymphedema to this date. This two-pronged approach allows to redirect lymphatic flow from the interstitial space in the subcutaneous layer to the venous system and helps regenerate lymphatics in areas where they may have been removed.
Liposuction to address lymphedema has also been described. It is more of a cosmetic treatment for lymphedema as the patient is still is left with permanent lifelong compression and reaccumulation of lymph as soon as the compression garment is removed. Liposuction does not treat the cause of lymphedema and therefore does not cannot be a long-term solution.
The power of Lymphatic Venous Anastomosis (LVA) and Lymph Node Transplant (LNT) lies in its ability to treat the causal pathway to lymphedema; it is a physiologic and long-term solution to improving lymphatic flow and ultimately, patient’s quality of life. I have personally seen and treated patients with dramatic improvements, that can range from 40% to 80% reduction in circumference, 60%-80% reduction in pain and swelling, with improved range of motion, wound healing, and improved quality of life by not having to wear compression or decrease the amount of time in compression.
I encourage patients who are trying to learn more about the latest treatments for lymphedema contact our office for more information and to continue learning more about the most advanced treatments for this difficult condition.