Surgical management of lower extremity lymphedema: A comprehensive review

Pedro Ciudad*, M. Diya Sabbagh, Mouchammed Agko, Tony C.T. Huang, Oscar J. Manrique, L. Carmen Román, Cesar Reynaga, Ricardo Delgado, Michele Maruccia, Hung Chi Chen

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

34 Scopus citations


Lymphedema refers to the accumulation of protein-rich fluid in the interstitial spaces. This can occur secondary to congenital malformation of the lymphatic channels or nodes or as a result of an insult that damages appropriately formed channels and nodes. Stagnant, protein-rich lymph initiates an inflammatory response that leads to adipocyte proliferation, fibrous tissue deposition, and increased susceptibility to infections. The end result is permanent disfigurement and dermal changes. Early and accurate diagnosis is essential, since lymphedema is a chronic and progressive problem. When lymphedema affects the lower extremity, it is important to manage it in a way that preserves function and mobility. Early diagnosis also allows for a proactive rather than reactive approach to treatment and utilization of novel physiologic procedures, such as lymphovenous anastomosis and vascularized lymph node transfer. Such interventions slow down disease progression and reduce morbidity by allowing the surgeon to salvage the remaining functional lymphatic channels.Whenphysiologicproceduresfailorwhenfacedwithadelayedpresentation, the addition of excisional procedures can provide a more comprehensive treatment of this debilitating disease. The aim of this article is to review the most current concepts in the surgical management of lower extremity lymphedema.

Original languageEnglish
Pages (from-to)81-92
Number of pages12
JournalIndian Journal of Plastic Surgery
Issue number1
StatePublished - 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2019 Association of Plastic Surgeons of India


  • Lower extremity lymphedema
  • Lymphedema
  • Radical reduction in lymphedema with preservation of perforators
  • Suction-assisted lipectomy
  • Vascularized lymph node transfer


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