Lymphedema

Upper extremity lymphedema is estimated to occur in up to 40% of breast cancer patients and represents one of the most debilitating sequelae of mastectomy. Most frequent in women who have undergone axillary dissection and radiation therapy, lymphedema is a chronic, debilitating condition which results in unremitting upper extremity swelling, deformity, and repeated bouts of infection. Non-invasive therapies, including external compression, manual lymphatic drainage, exercise, and skin care have been the primary treatment of lymphedema. However, these interventions are often time-consuming and painful, and long-term compliance is problematic.

Surgical therapy has traditionally been reserved for patients who fail to respond to conservative measures. Excisional procedures have included surgical debulking as well as suction-assisted removal of lymphedematous tissue.

The limitations of excisional procedures have led to the development of physiologic microsurgical procedures for the treatment of lymphedema. These include lymphaticovenous anastomoses and vascularized lymph node transfers. Lymphaticovenous procedures employ supermicrosurgical techniques to anastomose subdermal lymphatics to adjacent venules.

Vascularized lymph node transfer represents an exciting development in the treatment of post-mastectomy lymphedema. This technique imports healthy lymph nodes from a distant region of the body and connects them to arteries and veins in the upper extremity.