| | NOVEMBER 202219UTLOOKHealthcare Tech EMERGING STRATEGIES IN THE SURGICAL TREATMENT OF LYMPHEDEMALymphedema is a chronic and debilitating condition due to damage or obstruction of the lymphatic system that results in the build-up of protein-rich lymphatic fluid within the interstitium of affected tissues. Most common in the upper or lower extremity, patients report discomfort, pain, and the sensation of limb heaviness. Affected tissues swell due to a mismatch of fluid deposition in the setting of significantly reduced outflow, potentially leading to pathologic increases in limb volume, induration, fibrosis, cellulitis, and irreversible skin changes. In the United States and other developed nations, the most common cause of lymphedema is malignancy and associated treatments such as surgical extirpation, lymph node dissection, and radiotherapy. Alongside improved cancer screening and early detection methods ­ resulting in increased diagnosis before metastatic spread - is improved efficacy of locoregional treatment options (i.e., surgery and radiotherapy). As a result, the prevalence of lymphedema has also risen in recent years. In addition to significant morbidity and reduced quality of life scores associated with lymphedema, it is also associated with substantial healthcare spending and financial costs that must be borne by patients.The mainstay of lymphedema treatment consists of non-operative approaches, including physical therapy, manual lymphatic drainage, compression, and lymphatic massage. Given the relatively minimal benefit for many patients with conservative approaches, surgeons historically turned to excisional techniques such as debulking, direct tissue excision, and liposuction. These methods, however, similarly had limited benefit or were prohibitively morbid. In light of inadequate or unacceptable treatment options for lymphedema, novel surgical approaches that rely on reconstructive microsurgical principles are under investigation. The two most effective methods include lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT). These extremely complex techniques require significant technical expertise, expensive surgical equipment (e.g., high-power microscopes), and a hospital infrastructure capable of appropriate post-operative By Chad M. Teven, M.D. and Michael A. Howard, M.D., Microsurgery and Complex Reconstruction, Division of Plastic Surgery, Northwestern Medicine Lake Forest Hospital Chad M. TevenCXO INSIGHTS
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