Abstract: Comparing Outcomes Between Vascularized Lymph Node Transfer and Lymphovenous Anastomosis in the Treatment of Primary Lymphedema

Abstract

INTRODUCTION: Primary lymphedema is a devastating and debilitating disease. Much of the current treatment options demonstrate evidence in the treatment of secondary lymphedema. This study was to investigate the outcomes between vascularized lymph node transfers (VLNT) and lymphovenous anastomosis (LVA) in the treatment of primary lymphedema. METHODS: A total of 17 patients with a mean age of 31 (ranged 2- 57) years were recruited to the study with a total of 19 lower limbs with primary lymphedema. All patients reported a non-hereditary, occurrence of lymphedema without surgical and medical history. All patients were treated with either VLNT or LVA. Patients with a grade 1 or early grade 2 lymphedema were treated with LVA whereas late grade 2 to grade 4 patients received VLNT treatment. Quality of life and serial circumferential limb measurements including number of episodes of cellulitis were compared both pre and postoperatively. RESULTS: Fifteen limbs underwent VLNTs and had an average of 3.8 cm circumferential reduction above knee, 3.6 cm below knee and 4 cm above ankle with an average reduction of 3.7 cm. Four limbs received LVA treatment and had an average of 1.3 cm circumferential reduction AK, 3.0 cm BK and 1.5 cm AA, giving an average reduction of 1.9 cm. Follow-up was for an average of 19.7 ± 8.5 months. Patients in the VLNT group had an average cellulitis episode drop from 5.2 preoperatively to 0.1 postoperatively. Patients in the LVA group reported an average reduction in cellulitic episodes from 5 preoperatively to 0.8 postoperatively. In the VLNT group, an average significant improvement in overall quality of life was noted by 2.5 points. In the LVA group, an average improvement in the overall quality of life score was seen by 2 points. CONCLUSION: In conclusion, primary lymphedema can be effectively treated adequately with improvements in both functional and quality of life outcomes with appropriate lymphedema microsurgeries. VLNT when used in severe cases of lymphedema, can provide greater relief with more impactful outcomes in both functional restoration and quality of life outcomes.