Schedule Slot

In recent years, the management of lymphedema has evolved with the development of preventive surgical approaches, including immediate lymphatic reconstruction through lymphovenous anastomosis (LVA). Axillary and inguinal lymph node dissections are known to carry a considerable risk of postoperative complications. To address this issue, a new treatment protocol incorporation prophylactic LVA was introduced for patients undergoing lymphadenectomy for stage III metastatic melanoma, with the aim of reducing early postoperative complications as well as long term morbidity.

This cohort study compared a prospectively followed group of patients treated according to a new protocol including prophylactic LVA with a retrospectively analyzed historical control group treated without LVA. Patients undergoing lymph node dissection for stage III metastatic melanoma between August 2024 and December 2025 were included and compared with patients treated from 2020 to 2024. Patients- and treatment-related variables were evaluated, with particular attention to surgical management and postoperative complications.

In total, 116 patients underwent lymph node dissection, including 23 who received prophylactic LVA. The overall complication rate was significantly lower in patients who underwent LVA compared with those treated without LVA (26.1% vs 57%, p = 0.008). Seroma formation occurred in 52.7% of patients in the non-LVA group, whereas the incidence was significantly lower in the LVA group at 17.4% (p=0.002). Furthermore, 51% of patients who developed a seroma in the non-LVA group required sclerotherapy, while none of the patients who received prophylactic LVA required this intervention.

The use of prophylactic LVA in patients undergoing lymphadenectomy significantly reduces the risk of acute postoperative complications and decreases the need for sclerotherapy. This approach may therefore lessen the overall treatment burden for patients and contribute to improved clinical management.

The LYMPH-ICF upper- and lower-limb modules (LYMPH-ICF-UL/LL) are widely used patient-reported outcome measures (PROMs) to assess symptom burden and treatment response following conservative therapy and (super-)microsurgical lymphatic reconstruction. However, normative reference values from the general population are lacking, limiting interpretation of postoperative outcomes and residual morbidity. This study aimed to establish reference LYMPH-ICF-UL and -LL values from the non-affected general population to identify determinants of extremity-related quality of life.

In a cross-sectional benchmarking study, adults without a history of cancer or lymphatic disease were recruited over a seven-month period using QR code flyers/posters and social media. Participants completed the LYMPH-ICF-UL and LYMPH-ICF-LL questionnaires and a demographic health survey. Univariable and multivariable regression models were used to identify predictors of limb-related quality of life.

Of 695 participants, 553 (87.8%) responded to the LYMPH-ICF-UL and 491 (77.9%) further completed the LYMPH-ICF-LL. Mean total scores were 5.1 ± 11.2 and 4.5 ± 8.4 for upper and lower extremity, respectively. Increasing age and higher BMI were independently associated with worse scores across both extremities (p < 0.05). Female sex was independently associated with worse LL scores, while smoking was associated with worse UL scores. Physical activity demonstrated a protective effect.

These normative benchmark values provide a reference framework for evaluating surgical success and residual morbidity after lymphatic reconstruction. Given the significant influence of demographic and lifestyle factors on LYMPH-ICF scores, risk-adjusted interpretation is essential for accurate postoperative assessment and robust clinical trial design.

Within the contemporary revival of reconstructive lymphatic surgery, strategies aimed at preventing lymphatic damage are frequently underemphasized. Numerous clinical contexts in traumatic, oncologic, reconstructive, and aesthetic plastic surgery present distinct opportunities to minimize lymphatic injury and thereby avert subsequent morbidity. In this report, we describe our cumulative case series in which lymphatic vessels were identified preemptively-a strategy we designate as lymphatic mapping and preservation.

Preventive lymphatic mapping was carried out either indirectly-by ultrasonographic identification of the great saphenous vein and its branches and/or directly through indocyanine green (ICG) lymphography. Postoperative evaluation included clinical assessment for the development and grading of lymphedema, while duplex ultrasound was used to evaluate the continuity and patency of the great saphenous vein.

The series comprised 12 patients undergoing resection of medial thigh soft-tissue tumors, 3 cases with traumatic injuries, and 6 patients in whom mapping was performed for flap planning.
Preservation of the great saphenous vein-and, by implication, a substantial portion of the adjacent perisaphenous lymphatic network-was achieved in all cases except 4. Stage I or Il lymphedema developed in 6 patients, including 5 following soft-tissue tumor resection and 1 due to trauma.

Maintaining the integrity of the great saphenous vein together with the surrounding perisaphenous lymphatic-adipose tissue appears to reduce iatrogenic injury to lymphatic collectors and reduce the risk of related clinically significant complications. Lymphatic mapping and preservation represents a practical, reproducible technique that can be readily integrated into a broad range of surgical scenarios and subspecialties.

Lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) are two established techniques to treat lymphedema. However, the extent to which patient characteristics influence long-term treatment response remains insufficiently studied. Consequently, this study examined associations of sex, age, body mass index (BMI) with long-term outcomes after LVA and VLNT to inform clinical decision-making.

A prospectively maintained, multicentric lymphedema database was reviewed for patients who underwent unilateral LVA or VLNT for chronic extremity lymphedema between January 1, 2016, and December 31, 2025. Limb circumferences were recorded preoperatively and at standardized postoperative follow-up visits. Treatment response was quantified using the relative excess reduction rate (RERR). Postoperative complications were graded according to the Clavien–Dindo classification.

In lower extremity lymphedema, male patients showed significantly greater treatment response 12 and 24 months after LVA, as well as 24 months after VLNT. Higher BMI was associated with worse treatment response following upper extremity VLNT at 12 and 18 months, whereas no consistent BMI effects were observed in the lower extremity. Age showed no consistent effect. Neither variable significantly influenced postoperative complication rates.

Male patients with lower extremity lymphedema may demonstrate superior treatment responses than women, regardless of the surgical technique. On the other hand, high BMI predicts poorer response following upper extremity VLNT, underlining importance of preoperative weight loss. These findings support individualized procedure selection and highlight the need for confirmation in larger cohorts.

Lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) are established microsurgical treatments for extremity lymphedema. We investigated whether unilateral LVA or VLNT is associated with longitudinal contralateral limb volume change, stratified by upper versus lower extremity.

A prospective, multicenter database was screened for patients undergoing unilateral LVA or VLNT for chronic extremity lymphedema between January 2016 and September 2025. Bilateral limb circumferences were measured preoperatively and at standardized postoperative follow-up visits. Analyses were performed separately for upper and lower extremities, with subgroup comparisons between primary and secondary lymphedema.

In the upper extremity cohort, VLNT was associated with significant reductions in contralateral limb volume even when corrected for changes in BMI, whereas LVA demonstrated a non-significant but similar trend. In contrast, no contralateral effect was observed in lower extremity reconstructions, irrespective of the surgical technique. There were no significant differences between primary and secondary lymphedema.

Lymphatic reconstruction, particularly VLNT, may induce systemic lymphatic adaptations and lead to contralateral limb size reduction in the upper extremity. This observation expands the understanding of lymphatic physiology and may open new therapeutic avenues in lymphatic diseases, including distal neurolymphatic modulation.