Lee HS, Bae YC, Nam SB, Yi CR, Yoon JA, Kim JH.

The relationship between lymphedema severity and awareness of lymphedema surgery.

Arch Plast Surg. Sep 2021;48(5):534-542. doi:10.5999/aps.2020.02215

Lymphedema is the buildup of lymph fluid in the fatty tissues just underneath the skin. This build-up may cause swelling and discomfort. Lymphedema is progressive disease affecting the lymphatic system involving chronic inflammation, fibrosis, hyperkeratosis, and adipose deposition. This is most commonly seen after cancer treatments such as radiotherapy or lymph node dissection. In patients who undergo an axillary lymph node surgery for breast cancer, lymphedema can be as high 30% in the upper extremity. lymphedema can be treated with decongestive therapy such as compression. However now there are now surgical options for patients to reverse the process of lymphedema. Physiologic procedures such as lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) aim to improve the lymphatic drainage via physiologic mechanisms to reverse the lymphedema. For physiologic procedures such as LVA and VLNT it is important to perform treatment during early stages of lymphedema when physiologic procedures are still an option. Patients still need to practice compression therapy for the rest of their life once lymphedema develops.

Prior studies have shown that patients often have difficulty finding information regarding surgical management of lymphedema. Patients who do not have information about lymphedema and its surgical management are unlikely to undergo surgical treatment in the early stages of the lymphedema disease. Lee at al evaluated the relationship between patients’ awareness of lymphedema surgery and lymphedema severity at presentation. The authors looked to evaluate if patient education caused patients to recognize earlier stages of lymphedema. Fifty-two patients were evaluated at Pusan Hospital in Korea between 2017-2019. Patients completed a survey to evaluate their awareness of lymphedema. Patients were placed into the lymphedema treatment aware or unaware group. Lymphedema severity was classified according to the arm dermal backflow (ADB) stage and the MD Anderson Cancer Center (MDACC) stage based on indocyanine green lymphography. Physiologic surgeries LVA and VLNT were performed to treat lymphedema or excisional procedure such as liposuction based on patient choice. All patients used compression bandages or garments.

Lee et al found that patients who were aware of surgical operations for lymphedema presented early in the course of disease and a much higher percentage of patients who were aware of treatment options for lymphedema chose to undergo physiologic procedures such as LVA and VLNT. Early recognition of lymphedema is important for the success of physiologic procedures to treat lymphedema. Once the tissue has become fibrotic lymphedema persists and progresses and surgery is less likely an option. Therefore, it is essential to not only monitor patients for signs of lymphedema but also provide them with education and options regarding the development of lymphedema.