Overview

The surgical treatment of lymphedema has evolved over the recent few decades. With the addition of microsurgical techniques, new options are available to patients suffering from the physical and emotional sequelae of symptomatic lymphedema. The development of lymphatic microsurgery occurred much later than parallel specialties in microvascular and peripheral nerve microsurgery. This is likely due to the advancements in basic science research in these respective fields, as well as crossover understanding of common principles shared by these similar specialties. The study of lymphedema has been plagued with difficulty in directly assessing physiologic changes and structural components, reproducing surgical outcomes, and differences in evaluating clinical conditions. Recently, new technology, techniques, and improved skill-sets have resulted in an improved understanding of the disease process, which has in turn guided the development of new surgical techniques.

Much of the recent increased interest in this field can be attributed to the immense population of people suffering from either primary or secondary lymphedema. In industrialized countries, secondary extremity lymphedema continues to be prevalent in patients receiving comprehensive treatment for either breast or gynecologic cancers. Once symptomatic lymphedema occurs, few options exist for this subpopulation of patients who, many times, have fought emotional and physical battles through the cancer treatment process. Being able to provide valuable surgical and nonsurgical treatment options to this patient population has significant implications for not only the individual patient, but also the health care system. Cost considerations are valued in the physical strain and lost opportunity in various activities related to patients’ personal and professional lives.

Many controversies exist in the diagnosis and treatment of lymphedema including: universal diagnostic criteria, methods of limb measurements, and treatment options by variable medical specialties. The staging and treatment of lymphedema has no universal consensus among medical specialties, such as breast oncologists, gynecological oncologists, rehabilitation specialists, medical oncologists, radiologists/radiation oncologists, vascular surgeons, and reconstructive microsurgeons. Individualized clinical experiences lead to the disparate treatment options by various specialties, increasing the difficulties in choosing from the vast array of available alternatives for young surgeons.

Much of the interest related to lymphedema surgery among reconstructive microsurgeons has been garnered by the introduction of lymphovenous bypass and vascularized lymph node transfer techniques. Although these techniques have been described many decades ago, only recently has clinical interest surged in using these techniques. Using commonly learned microsurgical techniques, procedures resulting in lymphatic fluid shunting into the venous system can provide relief and decompression of a lymphedematous extremity. Furthermore, possibly re-establishing lymphatic connections can provide for an outflow of stagnant lymphatic fluid to flow centrally in the body. In addition to these techniques, reported clinical series have provided validation of these methods and have contributed further advances within the surgical community.

Born from these techniques and reinforced by enthusiastic surgeons, new surgical societies have been created, dedicated conferences have been held, and innovative techniques have been described. The compounding effects of these events have further strengthened the evolving and growing field of lymphedema surgery. The timely nature of this compilation of chapters cannot be underestimated. The rapid rise in interest in the surgical treatment of lymphedema necessitates a comprehensive understanding of not only the surgical treatment options available, but also the nonoperative and diagnostic modalities used in the care of this patient population. Many of the world’s authorities in their respective areas of expertise have made contributions to this textbook. With the vast experience treating these clinical conditions, the collection of authors provides a pragmatic and thoughtful approach that can be understood by all readers across all relevant specialties.

Principles and Practice of Lymphedema Surgery is structured in such a way as to provide the reader with an in-depth, practical knowledge of the disease process, nonsurgical treatment options, surgical treatment options, and scientific outcomes assessment. The intent of this logical, step-wise chapter list is to allow for the incorporation of treating patients with lymphedema into the clinician’s practice.