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Venkatramani et al. Plast Aesthet Res 2020;7:19 Plastic and
DOI: 10.20517/2347-9264.2019.70 Aesthetic Research

Review Open Access

Surgical debulking, lymphatico venous
anastomosis, vascularised lymph node transfer in

lower limb lymphoedema

Hari Venkatramani, Rajasabapathy Raja Shanmugakrishnan, Murugesan Senthil Kumaran,
Shanmuganathan Raja Sabapathy

Plastic, Hand & Reconstructive Microsurgery & Burns, Ganga Hospital, Coimbatore 641043, India.
Correspondence to: Hari Venkatramani, Plastic, Hand & Reconstructive Microsurgery & Burns, Ganga Hospital, Coimbatore
641012, India. E-mail: drhariv@gmail.com

How to cite this article: Venkatramani H, Shanmugakrishnan RR, Kumaran MS, Sabapathy SR. Surgical debulking, lymphatico
venous anastomosis, vascularised lymph node transfer in lower limb lymphoedema. Plast Aesthet Res 2020;7:19.
http://dx.doi.org/10.20517/2347-9264.2019.70

Received: 7 Dec 2019 First Decision: 4 Mar 2020 Revised: 30 Mar 2020 Accepted: 7 Apr 2020 Published: 17 Apr 2020
Science Editor: Xiao Long Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Lymphoedema is a chronic debilitating disease of the lymphatic system that occurs due to either abnormal
development or damage of the lymphatics resulting from cancer or infection. The optimal treatment of
lymphoedema is still elusive. Management is tailored according to clinical features, investigations and expectations
of each patient. Lymphoedema patients should undergo a trial of conservative management with compression
therapy, manual lymphatic drainage and external sequential compression devices. Early lymphoedema is
treated by lymphovascular anastomosis, where the lymph vessels are connected to the subdermal veins by
supermicrosurgery. In late cases when the limb is fibrotic, vascularised lymph node transfers are done, where
lymph nodes are transferred from a healthy area to the affected area. In advanced cases, when the limb is fibrotic
with cutaneous folds and skin changes, surgical debulking is done. In lymphoedema, along with accumulation of
lymphatic tissue, there is also fat deposition, which can be removed by liposuction. One should be conversant with
all treatment modalities to provide the lymphoedema patient with optimal care.

Keywords: Lymphoedema, lymphovascular anastomosis, vascularised lymph node transfers, liposuction, surgical
debulking

INTRODUCTION
Lymphoedema is a chronic debilitating disease of the lymphatic system that affects more than 250 million
[1]
people worldwide . Lymphoedema results from abnormal development or damage of the lymphatics due
© The Author(s) 2020. 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,
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