SP41. Surgical Management of Lymphedema: The Cleveland Clinic 2-Year Experience

PURPOSE: Surgical management of lymphedema in our institution is individualized depending on the patients’ conditions. Fluid-predominant lymphedema is treated with lymphaticovenular anastomosis (LVA) or vascularized lymph vessel transplant (VLVT) based on the severity of lymphatic injury. Solid-predominant disease is treated initially with liposuction, followed by possible staged reconstruction with LVA or VLVT. Herein we review our 2-year experience with this treatment protocol. METHODS: All lymphedema patients who underwent lymphedema surgery by the senior author at Cleveland Clinic in February 2020 to April 2022 were included. All patients were assessed with standardized evaluation including presence/relief of symptoms, physical examination, and indocyanine green (ICG) lymphography preoperatively and at regular postoperative intervals. RESULTS: 140 patients (152 limbs) with mean age of 55 years met the inclusion criteria. 57 (38%) limbs had LVA, 2 (1%) had VLVT, 89 (59%) underwent liposuction and only 4 (2%) had hybrid surgery consisting of liposuction followed by LVA (n=2) or VLVT (n=2). 64% of patients had secondary lymphedema (36% primary) and 66% had leg lymphedema (34% arm). Mean disease duration was 11 years. Mean follow-up was 10.5 months. The mean number of LVA anastomoses was 7.9 ± 3.1 and average lipoaspirate volume was 2.6 ± 1.1 L. All patients reported notable relief of symptoms, with confirmatory favorable physical examination and ICG lymphography findings at 3 months (88%, n=104/118), 6 months (92%, n=63/68) and 12 months (98%, n=56/57) postoperatively. CONCLUSION: Lymphedema surgery when tailored to patients’ individual conditions can yield satisfactory and favorable results. Hybrid surgery, although a popular concept, is commonly unnecessary.