Lymphovenous anastomosis during axillary or inguinal node dissection for preventing secondary lymphoedema

The condition

2.1 Lymphoedema is the build-up of lymph fluid in a limb, causing swelling of that limb. It is a common complication after treatments for various cancers, and can be chronic and debilitating. The condition can severely damage the skin, and cause aching in or difficulty moving the affected limb. There can also be recurrent skin infections, needing frequent antibiotic use and sometimes hospitalisation.

Current treatments

2.2 There are no curative treatments but there are various treatments to help control the symptoms of lymphoedema. They aim to reduce swelling and infection while improving lymphatic flow in the body, and include:

The procedure

2.3 This version of lymphovenous anastomosis is done during axillary or inguinal node dissection to reduce the risk of lymphoedema developing after surgery. This procedure, also known as LYMPHA (lymphatic microsurgical preventive healing approach), involves creating a bypass from the transected lymphatics to nearby veins. Before the node dissection, a blue dye is injected to map the lymphatic circulation from the arm or thigh. During the node dissection, the surgical team inserts the cut lymphatic vessels into a small branch of the axillary or saphenous veins with the aim of restoring normal lymph flow.

2.4 The standard LYMPHA technique is done by surgeons with microvascular experience, using an operating microscope and, typically, 9‑0 to 12‑0 sutures.

2.5 There is also a simplified technique known as S‑LYMPHA, which can be done by surgeons without microsurgical training, without an operating microscope and using 7‑0 sutures.