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Modern approaches to lymphatic surgery: a narrative review
Emily A Zurbuchen1, Nina Yu1, Ara A Salibian1
1Department of Plastic and Reconstructive Surgery, University of California, Davis Medical Center, Sacramento, CA, USA.
Summary
Surgical interventions for lymphedema, including physiologic and reductive methods, can improve patient outcomes. Addressing access and insurance coverage remains crucial for equitable lymphedema treatment.
Area of Science:
- Lymphedema management
- Surgical oncology
- Vascular surgery
Background:
- Lymphedema is a chronic condition caused by lymphatic system damage, leading to fluid and fat accumulation.
- Surgical procedures aim to treat lymphedema sequelae and reduce risk.
- Literature review on current surgical treatments, imaging, and future directions.
Purpose of the Study:
- To review current surgical treatment options for lymphedema.
- To explore imaging approaches in lymphedema management.
- To identify challenges in accessing surgical treatments and insurance coverage.
Main Methods:
- Systematic review of PubMed, Embase, and Cochrane Library databases.
- Identification of physiologic and reductive surgical methods for lymphedema.
- Analysis of patient access and insurance coverage challenges.
Main Results:
- Lymphatic surgery is categorized into physiologic (e.g., lymphovenous bypass, vascularized lymph node transplant) and reductive (e.g., suction lipectomy, excisional procedures).
- Advances in imaging and supermicrosurgical techniques improve clinical outcomes.
- Access to care and insurance coverage remain significant challenges.
Conclusions:
- Lymphatic surgery can enhance lymphedema patient symptoms and quality of life.
- Understanding predominant pathology (fluid vs. fat dominant) guides surgical management.
- Equitable access and insurance coverage for lymphedema surgery are essential.
