The purpose of surgery for lymphoedema is to restore damaged lymphatic outflow. This is accomplished by two microsurgical techniques which are often performed sequentially in order to achieve the best result - connecting lymphatic vessels to small veins under the skin, and by transferring healthy lymph nodes to the limb affected by lymphoedema.
Lymphatico-Venular Anastomosis (LVA)
When lymphaticovenular anastomosis (LVA) is performed, small incisions measuring 2-3cm are made on the skin of the patient’s extremity. The surgeon then looks for viable lymphatic vessels, which are generally less than 1mm in diameter.
These small channels are then connected under a high magnification microscope to tiny veins using sutures, which are thinner than the human hair. This procedure creates new pathways, allowing lymphatic fluid, which has accumulated in the obstructed lymphatic system, to divert into the venous system bypassing the obstruction.
Lymph Node Transfer (LNT)
With lymph node transfer (LNT), a group of healthy lymph nodes is harvested together with their nourishing blood vessels from the groin, neck or another area of the body. The lymph nodes are transferred to the area affected by lymphoedema to restore lymphatic outflow.
The blood vessels of the lymph nodes are joined under the microscope to recipient vessels. This allows the preservation of blood flow to the lymph nodes; ensuring their survival in the new location. The newly transferred lymph nodes stimulate the growth of new lymphatic vessels, thereby improving the lymphatic outflow circulation.
These are very delicate surgical techniques which can only be accomplished by a plastic surgeon highly skilled in microsurgery. Due to the small size of vessels involved, some doctor’s call it ‘super microsurgery’.
Lymphoedema Surgical Service has been set up by two UK consultant plastic surgeons, Mr. TC Teo and Mrs. Elen Prousskaia – both of whom are available for consultation at The McIndoe Centre – in the south east of England.