Abstract
Millions of people worldwide suffer from lymphedema. In developed nations, lymphedema
most commonly stems secondarily from oncologic treatment, but may also result from
trauma. More recently, lymphedema has been identified in patients after gender-affirmation
phalloplasty reconstruction. Regardless of the etiology, the underlying pathophysiology
involves blockage of lymphatic flow, resulting in lymph stasis, thus triggering a
cascade of inflammation culminating in fibrosis and adipose deposition. Recent technical
advances led to the refinement of physiologic and reductive surgeries—including lymphovenous
anastomosis and free functional lymphatic transfer, which collectively encompass a
variety of flap procedures including lymph node transfer, lymph channel transfer,
and lymphatic system transfer. This article provides a summary of our approach in
the assessment and management of the lymphedema patient, including detailed intraoperative
photography and imaging, in addition to advanced technical considerations in physiologic
reconstruction.
Keywords
lymphedema - lymphovenous anastomosis - lymphovenous bypass - supermicrosurgery -
VLNT - vascularized lymph node transfer - LYST - VLCT - VLVT - FFLT - free functional
lymphatic transfer
