Surgical Treatment for Lymphedema: State of the Art

This special topic issue for the Journal of Reconstructive Microsurgery will address the most current and updated information available on surgical treatment of lymphedema. We will also consider imaging modalities for the study of the lymphatic system and assessment of patients with lymphedema.

Lymphedema is the result of damage to the lymphatic system for a variety of reasons. The literature often categorizes lymphedema as either primary, which encompasses both the sporadic and hereditary forms, or secondary, when an apparent underlying cause such as infection, malignancy, or surgery is identified. This division, however, is losing relevance as we become more and more aware that genetic variations can explain the susceptibility in some individuals to develop lymphedema, even if the exact cause is unknown.[1]

In western countries, the most frequent type of lymphedema is cancer-related lymphedema, mainly secondary to breast cancer, melanoma, gynecologic or urologic cancers, and their relative treatments. The overall incidence of breast-cancer–related lymphedema is 6 to 30% of the survivors.[2] The incidence of lower limb lymphedema in women with cervical and vulval cancers is 20 to 49%, while after ilioinguinal lymph node dissection for melanoma it is around 20% of the patients.[3]

In later stages, the symptoms of lymphedema can be severe and disabling. Nevertheless, until a few years ago the only treatment that could be offered to patients was conservative, involving physical and medical therapy. Such approaches are helpful but provide no definitive benefit.

In the recent years, several surgical techniques have been described for the treatment of lymphedema, but no consensus about the most effective approach has been reached. Such techniques range from liposuction to microsurgical and supermicrosurgical techniques. Recent research on lymphangiogenesis and related growth factors has also opened a new window on treatment options for patients with lymphedema.

Progress in lymphedema treatment is also partly due to the recent development and refinement of imaging techniques that allow us to visualize and study the lymphatic system. These imaging techniques, together with accurate cadaveric studies, have considerably improved our knowledge about the anatomy and physiology of the lymphatic system. Nevertheless, many questions have yet to be answered and many problems have yet to be solved.

This special issue has been designed to provide the reader with an overview of the most current topics regarding lymphedema, offering points for reflection on unsolved topics. All the authors have been invited to contribute on the basis of their expertise in a certain topic.

I hope that this collection of articles provides the reader with a cornerstone for the management of lymphedema and serves to foster development in assessment and treatment for these patients.

• References

• 1 Rockson SG. The unique biology of lymphatic edema. Lymphat Res Biol 2009; 7 (2) 97-100
• 2 Card A, Crosby MA, Liu J, Lindstrom WA, Lucci A, Chang DW. Reduced incidence of breast cancer-related lymphedema following mastectomy and breast reconstruction versus mastectomy alone. Plast Reconstr Surg 2012; 130 (6) 1169-1178
• 3 Williams AF, Franks PJ, Moffatt CJ. Lymphoedema: estimating the size of the problem. Palliat Med 2005; 19 (4) 300-313