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3 Supermicrosurgeries for Cancer Patients Reduce Lymphedema Threat

December 07, 2021

Plastic and reconstructive surgeons at Orlando Health Cancer Institute are improving lymphedema outcomes through innovative supermicrosurgery techniques.

Richard D. Klein, MD
Richard D. Klein, MD

Traditionally, compression and therapy were the only available options for relief of this debilitating disease. Now, with advancements in supermicrosurgery, Orlando Health can offer relief through surgical options. Performed only at a few centers across the nation, vascularized lymph node transfers (VLNT) and lymphovenous bypasses (LVBP) can improve outcomes for those with lymphedema, often resulting from cancer treatment. LYMPHA (LYmphatic Microsurgical Preventative Healing Approach) is a novel protocol for lymphedema prevention in breast cancer patients at the time of the lymph node dissection. 

Vascularized Lymph Node Transfers

Kenneth R. Lee, MD
Kenneth R. Lee, MD

During VLNT, a small number of the patient’s healthy lymph nodes are harvested with blood supply and transplanted to the lymphedema-affected areas. Once the nodes’ blood supply is reestablished, the nodes can drain excessive lymphatic fluid, decreasing the need for conventional therapy. The patient’s progress can be measured by different levels of improvement. Proven effective when done within the first few years of lymphedema, the treatment can result in a volume reduction up to 90 percent. Most patients feel less heaviness of the arm, reduce or eliminate the infections associated with lymphedema and reduce their volume.

A surgical team led by Kenneth Lee, MD of the Orlando Health Aesthetic & Reconstructive Surgery Institute performed the first VLNT procedure in Florida in 2013. Since then, the team at Orlando Health Cancer Institute has performed more than 500 VLNT surgeries with patients from 38 states and achieved good long-term results.

Lymphovenous Bypass

Lymphedema 1 web
Lymphedema Treatment: Before & After

With LVBP, lymphatic vessels are sewn to nearby small veins to alleviate the effects of lymphedema. This form of surgery is referred to as supermicrosurgery because the vessels measure on average less than 0.5 mm in size. It was originally described and developed to alleviate lymphedema symptoms by allowing lymph fluid to drain directly into veins. LYMPHA is a form of LVBP that is performed at the time of a lymph node dissection and was recently developed in Italy.

LYMPHA

At the time of a lymph node dissection, axilla or groin, individual lymphatic channels are identified and mapped using a triple dye technique. Instead of clipping these channels leading to lymphatic blockage, the channels are imbricated into an adjacent vein using 10-0 sutures. Bypassing these 0.1 mm to 0.8 mm channels directly into a vein restores normal lymph flow and reduces the risk of developing lymphedema in the affected extremity.

As nationally recognized leaders in the field of microsurgery, Orlando Health Cancer Institute specialists adopted the LYMPHA protocol two years ago and have since completed more than 150 surgeries. All breast cancer patients at Orlando Health Cancer Institute during the past two years received the LYMPHA procedure at the time of the lymph node dissection.

Orlando Health hospitals are recognized among the nation’s best through the IBM Watson Health 100 Top Hospitals study for 2021.

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