Surgical Options for Lymphoedema and Future Directions
Lymphoedema is a long-term condition where lymph fluid builds up in the arms, legs or other parts of the body. This causes swelling, heaviness, discomfort, and sometimes infections. While compression garments, lymphatic massage, and exercise can help in the early stages, advanced lymphoedema often requires surgery. Thanks to recent developments, surgical options are now more effective than ever, offering better outcomes and improved quality of life for patients.
Surgical options for lymphoedema
Lymphaticovenous Anastomosis (LVA)
What it is: LVA is a microsurgical procedure where tiny lymphatic vessels are connected directly to nearby veins. This creates a new route for lymph fluid to drain naturally.
Benefits:
- Minimally invasive with very low complication rates.
- Can reduce swelling and lower the risk of infections.
Limitations:
- Works best in early-stage lymphoedema when lymphatic vessels are still healthy.
- Less effective if the swelling has become firm or fatty.
Vascularised Lymph Node Transfer (VLNT)
What it is: VLNT involves moving healthy lymph nodes from one part of the body, such as the groin or abdomen, to the swollen area to help restore proper lymphatic drainage.
Benefits:
- Effective for more advanced lymphoedema.
- Can reduce infections and improve limb size and comfort.
Limitations:
- A longer operation with a moderate risk of complications.
- Small chance of swelling at the site where the nodes are taken.
Liposuction (Suction-Assisted Lipectomy – SAL)
What it is: Liposuction removes excess fatty tissue from limbs where swelling has become fat-dominant rather than fluid-based.
Benefits:
- Very effective for long-standing, firm swelling.
- Improves appearance, comfort, and mobility.
Limitations:
- Does not repair the lymphatic system itself.
- Lifelong use of compression garments is necessary to maintain results.
Excisional Procedures (e.g., Charles Procedure)
What it is: In severe cases, surgeons remove thickened skin and tissue to reduce limb size and improve function.
Benefits:
- Can save limbs when other treatments are not possible.
Limitations:
- Higher risk of complications and scarring.
- Usually considered only as a last resort.
Future Directions in Lymphoedema Surgery
Advanced Imaging Techniques
New imaging methods, such as near-infrared fluorescence and indocyanine green (ICG) lymphography, allow surgeons to see which lymphatic vessels are working. This helps plan surgeries more precisely, improving the success of procedures like LVA and VLNT.
Wearable Compression Devices
Innovative wearable devices provide gentle, dynamic compression and massage to help move lymph fluid. They can be used alongside traditional compression garments to reduce swelling and support long-term results.
Emerging Innovations in Lymphoedema Surgery
Researchers are exploring new techniques, including robotic-assisted microsurgery, to improve precision in lymphoedema treatment. Early results from specialised centres are promising, but these methods are experimental, not widely available, and long-term outcomes are still being studied.
A final word
Surgery for lymphoedema is not a cure, but it can greatly improve comfort, mobility, and quality of life when other treatments are insufficient. The best surgical option depends on the stage of the condition and whether the swelling is mainly fluid or fatty. Choosing an experienced surgical centre is essential for personalised care and long-term success.
We hope this information is useful for you. If you need advice or have any questions about our treatments, please contact us. You can find us in Mill Hill Broadway and Islington. We are always happy to help. If you like this blog, please share!
References:
- https://pubmed.ncbi.nlm.nih.gov/39806245/
- Lymphovenous Anastomosis https://www.sciencedirect.com/topics/medicine-and-dentistry/lymphovenous-anastomosis
- Lymphoedema: https://www.nhs.uk/conditions/lymphoedema/
