Reconstructive surgery aims to intervene in early stage lymphoedema. Such patients have symptoms without swelling, or swelling that responds well to compression. By create new lymphatic fluid pathways around obstructions, surgery can improve flow and reduce pressure within the limb. This can result in reduced limb size, pain, and infection. When performed very early, lymphoedema may be prevented from progressing beyond its initial stages.

Lymphovenous anastamosis (LVA)

LVA is minimally invasive surgery, often performed through a small incision under local anaesthetic. Advanced imaging is used to find an intact lymphatic vessel, usually 0.3-0.8mm in diameter. Using a high powered surgical microscope, the lymphatic is delicately joined to a nearby vein with special microsurgery tools and techniques. Fluid can then flow directly into the bloodstream, bypassing obstructed upstream lymphatics and relieving pressure on the limb.

Despite the small size of the operation, LVA can reduce swelling over time, improve symptoms, and reduce infections. It may prevent lymphoedema from progressing further. The recovery is typically short and straightforward (day surgery), and complications are rare.

While some patients experience great benefits from LVA surgery, this is not universal and some have more modest outcomes. Also, the procedure works best in early stage lymphoedema – it is not effective when the condition is advanced.

Vascularised Lymph Node Transfer (VLNT)

VLNT surgery involves identifying a block of tissue, elsewhere in the body, which contains healthy lymph nodes and lymphatics. The blood circulation sustaining this tissue block is dissected. The tissue is then transplanted into area affected by lymphoedema, using microsurgery to reconnect the blood circulation to a nearby artery and vein. The transplanted lymphatic tissue provides a new pathway for fluid to drain from the area.

Donor lymph nodes can be found in multiple areas of the body, including the neck, armpits, groins, and inside the abdomen around the small bowel.

The benefits of VLNT are similar to LVA. Over time, the limb may reduce in size, along with reduction in symptoms and infection.

VLNT is a longer and more invasive surgery than LVA, requiring larger scars. Correct planning is critical in order to avoid causing lymphoedema at the harvest site, and nearby important structures must be preserved. While VLNT microsurgery is easier than LVA (because arteries and veins are larger than lymphatics), technical errors can cause blood clots which result in operative failure. Therefore, patients undergoing VLNT are typically admitted to hospital for several days for observation.