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Rajaram et al. Plast Aesthet Res. 2025;12:6 Plastic and
DOI: 10.20517/2347-9264.2024.147
Aesthetic Research

Review Open Access

Non-vascularised lymph node transfer: future
directions for the minimally invasive surgical

management of lymphoedema

1,2
Rohan Rajaram 1,2 , Jevan Cevik , Warren Matthew Rozen 1,2
1
Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston 3199, Australia.
2
Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston 3004, Australia.
Correspondence to: Dr. Jevan Cevik, Department of Plastic and Reconstructive Surgery, Peninsula Health, 2 Hastings Road,
Frankston 3199, Australia. E-mail: jevancevik@gmail.com

How to cite this article: Rajaram R, Cevik J, Rozen WM. Non-vascularised lymph node transfer: future directions for the
minimally invasive surgical management of lymphoedema. Plast Aesthet Res. 2025;12:6. https://dx.doi.org/10.20517/2347-
9264.2024.147
Received: 11 Nov 2024 First Decision: 13 Feb 2025 Revised: 23 Feb 2025 Accepted: 6 Mar 2025 Published: 14 Mar 2025

Academic Editor: Ning-Fei Liu Copy Editor: Ting-Ting Hu Production Editor: Ting-Ting Hu

Abstract
Lymphoedema is a common and debilitating condition for which there is no single satisfactory management
modality. Physiotherapy is accessible and moderately effective but suffers from the necessity for daily adherence.
Surgery is effective in the earlier stages of disease progression but can be morbid and demanding for patients. An
evolving surgical technique known as non-vascularised lymph node transfer (NVLNT) aims to tackle the underlying
lymphatic drainage deficit in lymphoedema in a minimally invasive manner. Emerging evidence demonstrates
promise in animal models and there is very nascent human evidence with mixed results. This is a narrative review
that examines the available animal and human literature on NVLNT and draws comparisons between the two to
discover methods of translating animal research to human applications. A systematic search was conducted.
PubMed and Embase were searched using MeSH terms for NVLNT. Ultimately, 17 papers, including 14 animal and
3 human studies, were found. Within animal studies, NVLNT is efficacious, with results being repeated multiple
times. Additionally, methods of optimising lymphangiogenesis, such as the addition of platelet-rich plasma and
VEGF-C in addition to fragmentation and pre-inflammation techniques, have been investigated with general
success. To date, evidence from human studies is sparse, with few studies, small sample sizes, and variable
outcomes. NVLNT is promising as a minimally invasive surgical treatment for lymphoedema; however, further
high-quality research in humans with advanced lymphoedema is necessary to prove its validity. Furthermore,
adjuvants to grafting explored in animal studies, such as VEGF-C therapy, may increase the efficacy of lymph node

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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