American Surgical Association

ASA Home ASA Home Past & Future Meetings Past & Future Meetings

Back to 2025 Abstracts

Improvement of the Natural Progression of Extremity Lymphedema Treated with Lymphatic Microsurgery
*Marco Pappalardo1, *Chia-Yu Lin2, *Chieh Lin3, Kevin Chung4, *Ming-Huei Cheng2
1Division of Plastic and Reconstructive Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio, Emilia, Italy; 2A+ Surgery Clinic, Taipei, Taiwan; 3Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 4Division of Plastic Surgery and Hand Surgery, Michigan Medicine, Ann Arbor, MI

Objective: The natural progression of extremity lymphedema involves the accumulation of interstitial lymph, frequent cellulitis, adipose deposition and fibrosis. The condition significantly reduces the quality of life. The study aimed to assess the impact of complete decongestive therapy (CDT) and lymphedema microsurgery (LM) on the natural progression of extremity lymphedema.
Methods: We performed an analysis of prospectively-collected data on all patients with extremity lymphedema (Lymphedema Grade I-IV) who were treated with either CDT or LM between November 2011 and September 2019. Patients were followed for two years. Patients with other vascular diseases, chylous ascites, bilateral lymphedema, or incomplete radiological examinations were excluded. CDT was administered to patients who preferred conservative management or refused surgical treatment. Patients were treated with LM according to predetermined Cheng’s Lymphedema Grading (CLG) and Taiwan lymphoscintigraphy staging (TLS) criteria. Primary outcomes included TLS for evaluating lymphatic drainage, episodes of cellulitis for infection, limb circumference and volume for adipogenesis, and tissue softness for fibrosis. Secondary outcome was the Lymphedema Quality of Life (LymQOL) questionnaire.
Results: Sixty-one patients were treated with CDT (mean age 60.5+12.7 years, M:F ratio 4:57) and 118 with LM (mean age 56.2+13.7years, M:F ratio 8:110). Among the patients treated with LM, 21 patients underwent lymphovenous bypass and 97 vascularized lymph node transfer. Patients in the CDT and LM treatment groups had a similar age, gender, BMI, duration of lymphedema, limb distribution (L:R and arm:leg), etiology of lymphedema, TLS before treatment and number of episodes of cellulitis in the affected limb in the year before protocol treatment.
At one-year of follow-up, patients in the LM group showed significant improvements in mean TLS (3.77+1.48 vs. 2.67+1.33, p<0.0001), and mean volumetric difference (43.2±25.8 vs. 31.7±21.7, p = 0.00025). At two-years of follow-up, the LM group showed further significant improvements in mean episodes of cellulitis (2.39+2.05 vs. 0.77+1.04, p<0.0001), mean circumferential difference (23.4+11.3 vs. 14.3+11.0, p<0.0001), and tissue-softness grade (2.41+1.15 vs. 1.42+0.633, p<0.0001). Additionally, improvements were noted across all five QoL domains at 1 and 2 years in the LM patients (all P<0.0001). No significant improvements were observed in the CDT group for primary or secondary outcomes.
Conclusions: Patients treated with LM demonstrated significant improvements in the natural progression of lymphedema with better outcomes and downgrades in TLS compared to those treated with CDT. LM is a more effective intervention for managing extremity lymphedema.
Back to 2025 Abstracts