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Page 8 of 9 Neligan. Plast Aesthet Res 2021;8:45 https://dx.doi.org/10.20517/2347-9264.2021.39

Figure 6. Algorithm for treatment of lymphedema, either primary or secondary. LVB: Lymphatico-venous bypass; VLNT: vascularized
lymph node transplant.

if they have areas of dermal backflow. In that case, a vascularized lymph node transplant (VLNT) to the area
of dermal backflow is considered.

On the other hand, if lymphatic channels are seen, the patients are divided into those who have or have not
had a lymph node dissection. Again, in either case, a lymphatico-venous bypass (LVB) is offered. Areas of
dermal backflow may again be eligible for VLNT. Six to twelve months after either LVB or VLNT, patients
are offered liposuction as these operations help improve lymphatic flow, but they do not address the
accumulated fibro-adipose accumulation, which we see with lymphedema.

Conclusion
Several treatment options exist for patients with lymphedema. Choosing the correct treatment is vital.
Patient assessment is of paramount importance in achieving this. There is no one test or finding that is
pathognomic for lymphedema, and we need to use multiple modalities to conduct a proper assessment.
These assessments are not just useful in the initial evaluation of these patients. They are also extremely
useful in following our patients and assessing the results of our treatment.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
The material is based on the authors’ practice. The bibliography provides all the information on issues
described and is available through PubMed.