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J Reconstr Microsurg 2025; 41(09): 752-760
DOI: 10.1055/a-2508-6778
Original Article

Clinical Variables Associated with Lymphedema Surgery: Physiologic versus Excisional

Authors

  • Jayna Lenders   *

    1   Section of Plastic and Reconstructive Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan

  • Christine S.W. Best   *

    1   Section of Plastic and Reconstructive Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan

  • Zachary J. Eisner

    1   Section of Plastic and Reconstructive Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan

  • Theodore A. Kung

    1   Section of Plastic and Reconstructive Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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Abstract

Background

As surgical interventions for lymphedema become increasingly available, it is important to understand characteristics of patients that undergo lymphedema surgery. The goal of this study was to define clinical variables of patients evaluated at a medical center who underwent lymphedema surgery to better inform which referred patients are surgical candidates.

Methods

A cross-sectional observational study was performed on patients referred to plastic surgery for lymphedema between January 2016 and June 2023. The operative group included patients who underwent lymphedema surgery, including physiologic surgery (PS) and excisional surgery (ES). The nonoperative group consisted of patients referred for lymphedema who did not undergo lymphatic surgery. Patient records were collected, and between-group comparisons were performed.

Results

A total of 285 total patients were identified (n = 66 operative, n = 219 nonoperative). The operative cohort had higher body mass index (BMI) than the nonoperative (33.5 vs. 31.2 kg/m2, p < 0.035) and was more likely to have undergone physical therapy/occupational therapy (68.2 vs. 53.4%, p = 0.005). Within the operative cohort (PS = 37, ES = 29), PS patients were more likely to be White (91.9 vs. 69.0%, p = 0.043) and have lower BMI (32 vs. 42.7 kg/m2, p = 0.007). PS patients were diagnosed for a longer period (8 vs. 3 years, p = 0.03) before seeing a plastic surgeon, more commonly had upper extremity lymphedema (43.2 vs. 13.8%, p = 0.016) and presented at an earlier lymphedema stage (stage 1 64.9 vs. 27.6%, p = 0.002). PS patients were more likely to have prior radiation (56.8 vs. 20.7%, p = 0.005), previous surgery (75.5 vs. 48.3%, p = 0.038), and prior lymphatic intervention (67.6 vs. 17.2%, p < 0.001) near the affected area.

Conclusion

Defining patient characteristics associated with surgical intervention for lymphedema can aid surgeons to increase the proportion of patients seen in clinic who are surgical candidates. Factors relating to oncological and surgical history in the affected area may suggest a patient is more likely to undergo PS.

Keywords

lymphedema - lymphedema surgery - lymphatic surgery center - physiologic surgery - excisional surgery

* Co-First Authors.




Publication History

Received: 04 September 2024

Accepted: 23 December 2024

Accepted Manuscript online:
30 December 2024

Article published online:
27 January 2025

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