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Tailoring Lymphedema Surgery to Individual Limb Segments: A Differential Approach
Sonia Kukreja-Pandey, Wei F. Chen
Lymphatic Supermicrosurgery, Dept of Plastic Surgery, Cleveland Clinic, Ohio
2024-01-15
Presenter: Sonia Kukreja- Pandey
Affidavit:
Original writing of the fellow based on my patients, not presented or published before
Director Name: Wei F. Chen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction: Disease severity in a lymphedematous limb is non-uniform. The distribution of fluid, fat, and fibrous deposits in lymphedematous limbs can vary across different regions, hence one surgery may not fit the whole limb. This study aimed to assess the patients who underwent distinct surgeries for different segments of the same limb.
Methods: Patients who underwent different lymphatic surgical procedures on different segments of the same limb between January 2020 and May 2022 were included. Standardized outcomes tracking involving patient-reported symptoms, clinical examination, and ICG lymphography was implemented at regular intervals.
Results: Of the 193 patients who underwent lymphedema surgery during the study period, 26 patients received staged procedures for different segments of the same limb.
19/26 patients (73.1%) underwent debulking liposuction separately for the thigh and leg, with an average interval of 6 ± 2 months. Three patients (11.5%) received lymphaticovenular anastomosis (LVA) in the leg (2) or forearm (1) followed by LVA in the foot or hand after an average period of 3±1 years, for persistent distal swelling.
In 7/26 patients (27%), LVA was performed on the legs (7/7) while debulking liposuction was performed on the thighs (6/7) or ankle (1/7), with an average interval of 9 ± 5 months between the procedures (Figures 1,2). At the latest follow-up, all patients demonstrated improvement in the standardized outcome measures.
Conclusion: Lymphedema surgery tailored to disease stage of individual limb segments optimizes outcomes.
