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J Reconstr Microsurg
DOI: 10.1055/a-2540-0648
Original Article

Surgical Treatment of Lymphedema at LE&RN Comprehensive Centers of Excellence

James E. Fanning
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Rosie Friedman
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Kathleen Shillue
2   Department of Rehabilitation Services, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Aaron Fleishman
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
William Repicci
3   Lymphatic Education and Research Network, New York, New York
,
Kevin Donohoe
4   Division of Nuclear Medicine, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Dhruv Singhal
1   Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding Research reported in this publication was supported in part by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number R01HL157991 (D.S.) and the NIH Common Fund under award number U54HL165440 (D.S.). James Fanning is supported by the 2024 JOBST Lymphatic Research Grant awarded by the Boston Lymphatic Symposium, Inc. Rosie Friedman was supported by the 2022 JOBST Lymphatic Research Grant awarded by the Boston Lymphatic Symposium, Inc. William Repicci is the president and chief executive officer of the Lymphatic Education and Research Network (LE&RN) and receives financial compensation for his employment. All other authors have no financial disclosures to report (K.S., A.F., and K.D.).
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Abstract

Background

Despite major advancements in lymphatic care, there remains a lack of consensus across institutions regarding the evaluation and surgical management of lymphedema. The aim of this study is to describe the practices for diagnosis and surgical treatment of lymphedema across accredited Lymphatic Education & Research Network (LE&RN) comprehensive Centers of Excellence (COEs).

Methods

A survey was distributed to directors of the 16 LE&RN comprehensive COEs in January 2023. Directors were queried on lymphatic surgeon training, evaluation of potential surgical patients, description of surgical operations offered at their center, surgical algorithms, and operative techniques for various procedures.

Results

Nine COEs completed the survey (56% response rate). Eight of nine centers reported having an interdisciplinary surgical evaluation program, including lymphatic surgery (100%, 8/8), certified lymphedema therapy (100%, 8/8), and lymphatic medicine (75%, 6/8). COEs use a variety of lymphatic imaging modalities, with indocyanine green lymphography (89%, 8/9) and lymphoscintigraphy (78%, 7/9) being the most common. While all COEs offered debulking procedures, 67% (6/9) offered physiologic procedures (lymphovenous bypass and vascularized lymph node transplant), and 56% (5/9) offered immediate lymphatic reconstruction. There was no consensus on surgical algorithms or operative approaches.

Conclusion

LE&RN comprehensive COEs consistently use multidisciplinary care teams for medical and surgical evaluations, but there is significant variability in lymphatic imaging modalities used and lymphatic surgery types and techniques. These findings underscore the need for continued research and standardization of lymphatic surgery outcomes to develop consensus.

Keywords

lymphedema - lymphatic surgery - breast cancer–related lymphedema - lymphatic - lymphatic imaging

Supplementary Material



Publication History

Received: 13 September 2024

Accepted: 26 January 2025

Article published online:
07 March 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
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