Surgical Treatment of Lymphedema

Lymphedema is a chronic condition that usually develops after cancer treatments or due to congenital causes and is manifested by fluid accumulation in the arms or legs. Removal of lymph nodes or radiotherapy, especially during breast cancer, gynecological cancers or melanoma treatments, may cause damage to lymph drainage pathways. This condition, which can be controlled with physical therapy and pressure applications in the early stages, causes permanent tissue changes in the advanced stages and surgical treatment may be required.

There are two basic approaches to the surgical treatment of lymphedema: volume-reducing excision techniques and microsurgery and procedures to reconstruct lymph circulation. Excision methods aim to reduce leg or arm volume by removing edematous and fibrotic tissues in advanced stage patients. In particular, vacuum-assisted techniques such as liposuction or direct excision of subcutaneous fibrosis fall into this group.

The aim of microsurgical techniques is to reestablish the disrupted lymph circulation. One of the most commonly applied methods is lymph node transfer. In this procedure, healthy lymph nodes taken from another part of the body (for example, groin, neck, supraclavicular area, intra-abdominal) are transplanted with their vessels to the lymphedema area. By providing vascular connections with microsurgery, these nodes are aimed to work in the new region. Thus, the drainage of lymph fluid is restarted.

Another important method is lymphatic bypass procedures. In this technique, blocked lymph channels are directly connected to small veins using microsurgery (lymphovenous anastomosis). In this way, lymph fluid is directed from the lymph system to the venous system, reducing edema. These procedures are generally more effective in early and mid-stage lymphedema.

Lymphedema surgery should be planned individually. The appropriate method is determined by evaluating the stage of the disease, tissue condition, past treatments and general health status. Continuing regular follow-ups after surgical treatment and continuing supportive treatments such as compression and physiotherapy are important for the success of the treatment. In suitable patients, microsurgical methods can significantly improve the quality of life.