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Systemic Echoes - How Lymphatic Reconstruction Surgery Extends Its Therapeutic Reach from Limbs to Head
Ali Foroutan
Wei F. Chen
Sonia Kukreja-Pandey
Cleveland Clinic
2025-01-10
Presenter: Ali Foroutan
Affidavit:
Dr. Wei Chen
Director Name: Dr. Wei Chen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Purpose
To describe two cases in which lymphaticovenular anastomosis (LVA) surgery in primary lymphedema patients produced systemic effects, with observations suggesting potential therapeutic benefits extending beyond the surgical sites.
Methods
We examined two cases of primary lymphedema presenting with multiregional lymphatic involvement, including head and neck swelling. Both patients reported cognitive symptoms at presentation. Global lymphatic insufficiency was demonstrated by indocyanine green lymphography (ICGL). After LVA surgery on a single symptomatic lower extremity, outcomes were assessed through patient-reported symptoms and follow-up ICGL.
Results
Both cases demonstrated systemic improvements following LVA surgery. Patient 1, a 37-year-old woman with facial, truncal, and extremity swelling, showed marked symptom reduction across all affected areas within one-week post-surgery. Interestingly, her reported difficulties with spontaneous speech improved. At 1 year post-surgery, she experienced further decrease in swelling and reported complete resolution of speech difficulties. Patient 2, a 62-year-old woman presenting with diffuse whole-body swelling, reported improvements in mental clarity and focus following surgery. ICGL confirmed improved lymphatic function in both patients, showing improved lymphatic transit and decreased dermal backflow in the treated limb.
Conclusion
Our findings suggest that primary lymphedema manifests as a systemic condition, where targeted lymphatic reconstruction can produce widespread effects. The unexpected observation of improved cognitive symptoms in both patients, while preliminary, raises intriguing questions about potential connections between peripheral and cerebral lymphatics. These observations challenge the traditional view of primary lymphedema as a purely localized condition. Further investigations are warranted to elucidate the relationship between peripheral lymphatic reconstruction and cognitive function, particularly regarding the potential impact on cerebral lymphatic circulation.
