Systematic Review of Vascularized Lymphatic Vessel Transfer for the Treatment and Prevention of Lymphedema

Lymphatic surgery has gained increasing attention over the years due to significant advancements and successful outcomes in treating lymphedema and other lymphatic complications. Cornerstone treatments remain lymphovenous anastomosis and vascularized lymph node transfer. However, the transfer of lymphatic-rich tissues, known as vascularized lymphatic vessels transfer (VLVT), represents a technically simpler alternative. Once largely overlooked, this has recently gained attention as studies have shown its promising potential.A systematic review of PubMed, Google Scholar, and Scopus was performed using relevant keywords. Only human studies in English were included, excluding case reports. References cited in selected articles were also reviewed. The study aimed to evaluate the effectiveness of VLVT for immediate lymphatic reconstruction (ILR) to prevent lymphatic sequelae and for lymphedema treatment (LT) based on both objective and subjective symptom improvement. Complication rates at donor sites were also assessed. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.After removing duplicates, the literature search identified 213 articles, of which 12 studies, including 182 patients, were deemed eligible. VLVT was used for LT in 59 patients and for ILR in 123 patients. Among patients treated for lymphedema, most showed subjective and objective improvement, statistically significant reductions in circumference, decreased cellulitis incidence, and symptom relief, as reported in questionnaires. However, the evaluation of results varied significantly across studies. No cases of condition worsening were reported. For the ILR cases, when lymph axiality was maintained, the treatment succeeded in all cases.VLVT represents a promising addition to the surgical armamentarium for the surgical treatment and prevention of lymphedema, offering significant potential for physiological lymphatic restoration and improved patient outcomes.