| Abstract: |
In the developed world, lymphedema predominantly affects survivors of breast, gynecologic, or urologic cancers, for whom it may be their greatest survivorship burden. Caring for lymphedema imposes a significant time burden on patients and their carers, and leads to cumulative and cascading economic consequences, in particular when complicated by infections. Recently, there has been rapidly growing interest in lymphedema driven by advances in nonsurgical and surgical treatments to reduce the functional and psychosocial disability of lymphedema. These modern surgical and supermicrosurgical procedures are delivered in concert with skilled conservative therapy to maximize the magnitude and consistency of outcomes from lymphedema surgery. Current gold-standard management of lymphedema recognizes the superior effectiveness of the multimodal multidisciplinary team approach delivered within lymphedema centers offering the highest standard of best practice multi-team comprehensive care. Indocyanine green (ICG) lymphography has been a significant advance as an important and practical tool for diagnosis and surgical decision-making, and to enable lymphovenous bypass (LVB) to be performed. Axillary lymphadenectomy and adjuvant radiation therapy often result in significant axillary scar contracture that limits arm range of motion. Lysis of the axillary scar adhesions combined with orthotopic proximal vascularized lymph node transplantation to the axilla can provide significant improvement in function and quality of life in addition to treating the lymphedema affecting the arm and trunk. In appropriately selected patients who are continuously compliant with compression garments with significant fibroadipose soft tissue excess that affects arm function, suction-assisted lipectomy (SAL) debulking surgery can achieve tremendous improvements in quality of life and limb function, as well as reducing the incidence of infections. Advances in pharmacological treatments are awaited and anticipated to significantly impact prevention and treatment of lymphedema. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved. |
