In general there are two approaches of lymphatic surgery. The ablative and the reconstructive procedures.
The ablative procedures
Over 100 years ago the first surgical approach for lymphedema surgery was published by Charles, named “the Charles Procedure”. It involved radical excision of all affected skin and subcutaneous tissues down to deep muscle fascia and coverage using skin grafts. Nowadays this procedure is obsolete, because it has severe complications like massive blood loss, postoperative infection and ends sometimes in amputations and death.
Today in the late stages of lymphedema, when the fibrotic alteration has take place, you can achieve a volume reduction by liposuction.
Over the last two decades the surgical treatment of lymphedema has gained popularity. The majority of patients have secondary lymphedema associated with breast cancer. But the problem involves a lot more cancer survivors as well as thousands of affected people with primary lymphedema. Recent advances and development in microsurgical techniques over the last decade have resulted in the introduction of promising, new approaches like:
- reconstruction with Lympho – Venous Anastomosis in “supermicrosurgery technique” (LVA)
- Vascularized Lymph Node Transfer (VLNT)