Outcomes of Vascularized Lymph Node Transfer and Lymphovenous Anastomosis for Treatment of Primary Lymphedema

Background: Primary lymphedema is a debilitating disease. This study was to investigate the outcomes between vascularized lymph node transfer (VLNT) and lymphovenous anastomosis (LVA) for treating primary lymphedema. Methods: Between January 2010 and December 2016, 17 patients with mean age of 31.5 +/- 15.5 (ranged, 2-57) years diagnosed with 19 primary limb lymphedema were recruited. Patients with patent lymphatic ducts on indocyanine green lymphography were indicated for LVA, whereas those without patent lymphatic ducts were indicated for VLNT. Circumferential limb measurements, body weight, episodes of cellulitis and Lymphedema Quality-of-Life (LYMQoL) questionnaire were compared between preoperatively and postoperatively. Results: Fifteen lymphedematous limbs underwent VLNT (79%) and 4 underwent LVA (21%). All VLNT flaps survived. At a mean follow-up of 19.7 +/- 8.5 months, mean reduction of limb circumference, body weight, and episodes of cellulitis were 3.7 +/- 2.9 cm and 1.9 +/- 2.9 cm (P= 0.2); 6.6 +/- 5.9 kg and 1.7 +/- 0.6 kg (P< 0.05); 5.1 +/- 2.8 times/y and 4.2 +/- 0.5 times/y in VLNT and LVA groups, respectively (P= 0.7). Improvements in overall score (from 3.9 +/- 1.2 to 6.4 +/- 1.1, P < 0.05) of the LYMQoL in VLNT group had statistical significant difference than that (from 3.0 +/- 1.4 to 5.0 +/- 2.4, P= 0.07) in LVA group. Conclusions: Both VLNT and LVA can effectively treat primary lymphedema patients. The reduction of above-knee circumference, body weight, episodes of cellulitis, and the improvement of LYMQoL was significantly greater in LVNT compared with LVA.