Lymphedema: current treatment strategies and future directions in tissue engineering

The lymphatic system is a part of the circulatory system, playing a crucial role in fluid balance and immune function. Dysfunction of the lymphatic system can lead to lymphedema, a chronic and progressive condition characterized by the accumulation of lymphatic fluid, resulting in tissue swelling, pain, and functional impairment. Lymphedema is classified as either primary or secondary. Primary lymphedema arises from congenital dysfunction of the lymphatic system and may be associated with various genetic syndromes or occur idiopathically. Secondary lymphedema is associated with damage, obstruction, or removal of previously normal lymphatic vessels or lymph nodes. Traditionally, management strategies for lymphedema have been predominantly conservative, and even now, conservative treatment with complete decongestive therapy remains the gold standard. However, in recent years, lymphatic surgical approaches such as lymphaticovenous anastomosis and vascularized lymph node transfer have been improved by advances in microsurgical techniques, with promising clinical outcomes. Equally important, lymphatic tissue engineering has emerged as a promising new direction in lymphedema treatment, introducing both new challenges and opportunities. The complex tissue and molecular alterations associated with lymphedema remain major obstacles to developing a universally applicable treatment algorithm. As no curative treatment is currently available, this review aims to provide a comprehensive overview of current therapeutic options for lymphedema, highlight key experimental advances in lymphatic tissue engineering, and discuss their potential translational applications.