Lymphedema is a condition that develops after breast cancer treatment and as a result of certain medical conditions. Alleviating the symptoms of lymphedema may require vascularized lymph node transfer in some patients. John R. Barbour, MD, FACS, is a triple board-certified plastic and reconstructive surgeon and fellowship trained hand and peripheral nerve specialist who offers vascularized lymph node transfer procedures for the residents of the Washington, DC, area, including Fairfax, Arlington, Alexandria and surrounding communities in Virginia.
Vascularized Lymph Node Transfer (VLNT)
Vascularized lymph node transfers (VLNT) have been shown to be an effective method for the treatment of the arm. Lymph nodes are taken from the donor area with their supporting blood vessels and moved to a new location in the axilla (armpit). Another technique involves implanting the nodes into the wrist of the arm affected by lymphedema.
Dr. Barbour then uses specialized microsurgical techniques to reconnect the blood vessels to new vessels, providing vital support to the transferred lymph nodes while they heal in the new area. The transferred lymph nodes then serve as a filter or conduit to remove the excess lymphatic fluid from the arm or leg and return it to the body’s natural circulation. This method of lymph node transfer can be performed independently or together with a DIEP flap breast reconstruction. The combined procedure allows for both the simultaneous treatment of the arm and the creation of a breast in one surgery. The DIEP flap reconstruction provides the opportunity for a beautiful and natural-appearing reconstructed breast combined with contouring of the abdomen (similar to a tummy tuck). The lymph node transfer portion of the surgery removes the excess lymphatic fluid to return form, softness, and function to the arm.
Lymphaticovenous Anastomosis (LVA)
When indicated for focal lymphatic blockage, Dr. Barbour will perform a lymphovenous bypass. This procedure uses microsurgery to build tiny bridges between the lymphatic vessels and the veins so that the lymph fluid has a new pathway out of the arm. Two to five small incisions measuring an inch or less are made in the arm or leg using tiny microsurgical tools. The surgeons redirect the lymphatic fluid to small veins to allow for drainage, thus alleviating lymphedema. The procedure takes about 2-4 hours under general anesthesia.
Almost anyone suffering from lymphedema of the arm or leg is a candidate for bypass surgery. However, patients who have had the condition for a shorter time tend to have better results. Results will vary from patient to patient. Some will see a significant improvement in their lymphedema symptoms, while others may experience no improvement at all. A complete cure from lymphedema should not be expected.
While the surgery may result in significant improvement of the lymphedema, continued therapy such as wearing of the compression garment, massage, skin care and exercise is recommended to obtain the best result. Lymphedema therapy should be resumed 4 weeks after the surgery.
Anastomosis (LVA) involves the use of supermicrosurgery to join lymphatic channels in the affected area directly to nearby veins. The lymphatics are quite small, typically approximately 0.1 mm to 0.3 mm in diameter. The procedure employs specialized techniques and superfine surgical sutures sewn with the aid of an adapted high power microscope. The procedure can be an effective and long-term solution for extremities. Patients must have excess fluid in the arm or leg with pitting issues to be candidates for this procedure. After the procedure, many patients significantly decrease or eliminate the use of their compression garments. LVA is the least invasive of the current procedures which we offer. Patients have the option of returning home the day of their procedure.
