Surgical treatments for lymphedema aim to grow new lymphatics or allow blocked lymphatics to drain. Although surgery does not cure lymphedema, when it is performed in the right patient it can reduce the burden of disease. Patients frequently report a reduction in the amount they need to wear their compression, a reduction in limb volume, and a lower number of cases of cellulitis. We emphasize that in order to benefit from surgery, patients must continue their compression therapy.
There are two main types of surgery for lymphedema: lymphovenous bypass (LVB) and vascularized lymph node transfer (VLNT). LVB is for patients who have functional lymphatic channels that are blocked. In this procedure, using a high-powered microscope, the lymphatic channels are attached to veins in order to bypass the blockage. VLNT is for patients who do not have functional lymphatic channels. For these patients, lymph nodes are taken, placed in the affected limb, and their blood supply is attached to a nearby blood vessel to keep the lymph nodes alive. These lymph nodes will help the affected limb to drain lymphatic fluid. At this time, we are only performing VLNT at the MUHC.
Who is a good candidate for lymphedema surgery?
Patient selection is a very important part of lymphedema surgery. If surgery is performed in a poor surgical candidate, they are at risk of worsening lymphedema or infections. The following criteria must be met in order to be considered for lymphedema surgery:
- BMI<35
- Compliant with therapy
- Limb volume reduction has plateaued with therapy
- Medical co-morbidities are well-controlled
- No metastatic cancer
- Non-smoker
- Realistic expectations
How do I refer a patient to the MUHC Surgical Lymphedema Clinic?
To refer a patient to the MUHC Surgical Lymphedema Clinic, please consult Dr. Joshua Vorstenbosch at:
- Phone: 514-934-1934 x 35194
- Fax: 514-843-2812