Surgical management of lymphedema. A review

Lymphedema is a chronic disease in which impaired lymphatic drainage causes the accumulation of fluid in the soft tissues, resulting in a swollen limb. This ultimately leads to severe fibrosis, recurrent infections, non-healing wounds, and a poorly functional limb that negatively affects patients' quality of life. Primary lymphedema is due to abnormal development of the lymphatic system, it can be present from birth, secondary lymphedema is caused by damage to the lymphatic system due to infection, surgery to treat malignant tumors, trauma and obesity. In the past, the only treatment was compression, which is still the first line of treatment today. In recent decades, surgical treatments for lymphedema have advanced, along with advances in microsurgery. Lymphovenous anastomosis (LVA) and lymph node transplantation are physiologic therapies that can reduce lymphedema by addressing the cause. Ablative techniques such as liposuction and subcutaneous excision help resolve the accumulation of proteinaceous and fibrotic adipose tissue seen in advanced lymphedema. The objective of this review is to examine the results and limitations of current surgical techniques used in the treatment of lymphedema.