Treatment of Moderate to Severe Lymphedema

Say Goodbye to Compression Garments after Dr. Cheng’s Lymphedema Microsurgery

Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs

Case 1

Vascularized Lymph Node Flap Transfer - Before Treatment photo, 61-year-old female

Preop

This is a 61-year-old female who had suffered from breast cancer-related lymphedema of the right upper extremity for 10 years after mastectomy, axillary 19 lymph nodes dissection, and radiotherapy. With the combined use of compression garments and the treatment of complete decongestive therapy, she had developed 2 episodes of cellulitis per year.

Before

2 Months

At 2- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 27% and 10% above and below the elbow, respectively.

After

12 Months

At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 36% and 15% above and below the elbow, respectively.

After

36 Months

The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 and 27 months. At 36- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 60% and 10% above and below the elbow, respectively.

After

72 Months

At 72- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 50% above and below the elbow, respectively.

After

75 Months

At 75- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 40% above and below the elbow, respectively.

After

Case 2

Vascularized Lymph Node Flap Transfer - Before Treatment photo, 53-year-old patient

Preop

A 53-year-old patient with grade II breast cancer-related lymphedema of the right upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was refractory to conservative decongestive therapy.

Before

3 Months

At 3- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 38% and 25% above and below the elbow, respectively.

After

6 Months

At 6- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 32% and 15% above and below the elbow, respectively.

After

12 Months

At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 30% and 15% above and below the elbow, respectively.

After

18 Months

The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At 18- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 90% and 40% above and below the elbow, respectively.

After

22 Months

At 22- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 35% above and below the elbow, respectively.

After

36 Months

At 36- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 85% above and below the elbow, respectively.

After

Case 3

Vascularized Lymph Node Flap Transfer - Before Treatment photo, 56-year-old patient

Preop

A 56-year-old patient with grade IV breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 5 episodes of cellulitis per year and was refractory to conservative decongestive therapy.

Before

12 Months

At 12- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 40% and 15% above and below the elbow, respectively.

After

21 Months

The skin paddle in the wrist was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At 21- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 70% and 30% above and below the elbow, respectively.

After

29 Months

At 29- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 65% above and below the elbow, respectively.

After

Case 4

Vascularized Lymph Node Flap Transfer - Before Treatment photo, 70-year-old patient

Preop

A 70-year-old patient with grade III breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 1 episodes of cellulitis per year and was refractory to conservative decongestive therapy.

Before

6 Months

At the 6-months follow-up, vascularized submental lymph node flap transfer to the wrist had significantly improved the patient’s symptoms and extremity tightness. The circumferential reduction rate was 20% above the elbow and 15% below the elbow without the use of a compression garment.

After

20 Months

The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in the wrist and liposuction for the left upper medial arm 14 months after surgery. At the 20-months follow-up, the reduction rate was 53% above the elbow and 15% below the elbow without the use of a compression garment.

After

24 Months

At the 24-months follow-up, the reduction rate was 60% above the elbow and 50% below the elbow without the use of a compression garment.

After

33 Months

At the 33-months follow-up, the reduction rate was 50% above the elbow and 25% below the elbow without the use of a compression garment.

After

50 Months

At the 50-months follow-up, the reduction rate was 80% above the elbow and 45% below the elbow without the use of a compression garment.

After

Case 5

Vascularized Lymph Node Flap Transfer - Before Treatment photo, 59-year-old patient

Preop

A 59-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 12 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was refractory to conservative decongestive therapy.

Before

3 Months

At the 3-months follow-up, vascularized submental lymph node flap transfer to the wrist had significantly improved the patient’s symptoms and extremity tightness. The circumferential reduction rate was 22% above the elbow and 25% below the elbow without the use of a compression garment.

After

6 Months

At the 6-months follow-up, the reduction rate was 35% above the elbow and 25% below the elbow without the use of a compression garment.

After

12 Months

At the 12-months follow-up, the reduction rate was 30% above the elbow and 20% below the elbow without the use of a compression garment.

After

24 Months

The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in the wrist and liposuction for the left upper medial arm 14 months after surgery. At the 24-months follow-up, the reduction rate was 35% above the elbow and 30% below the elbow without the use of a compression garment.

After

38 Months

At the 38-months follow-up, the reduction rate was 35% above the elbow and 30% below the elbow. The patient was satisfied with the functional and cosmetic outcomes and did not wear a compression garment.

After

Case 6

Vascularized Lymph Node Flap Transfer - Before Treatment photo, 51-year-old patient

Preop

A 51-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 6 months after mastectomy, axillary lymph node dissection, and radiation. She developed 1 episodes of cellulitis per year and was refractory to conservative decongestive therapy.

Before

12 Months

At the 12-months follow-up, the reduction rate was 50% above the elbow and 33% below the elbow without the use of a compression garment.

After

12 Months

At the 12-months follow-up, the reduction rate was 50% above the elbow and 33% below the elbow without the use of a compression garment.

After

20 Months

At the 20-months follow-up, the reduction rate was 50% above the elbow and 77% below the elbow without the use of a compression garment.

After

20 Months

At the 20-months follow-up, the reduction rate was 50% above the elbow and 77% below the elbow without the use of a compression garment.

After

36 Months

The patient received a revision surgery consisting of the de-epithelialization of the skin paddle in 24 months after surgery. At the 36-months follow-up, the reduction rate was 50% above the elbow and 50% below the elbow without the use of a compression garment.

After

36 Months

After

40 Months

At the 40-months follow-up, the reduction rate was 70% above the elbow and 75% below the elbow without the use of a compression garment.

After

40 Months

At the 40-months follow-up, the reduction rate was 70% above the elbow and 75% below the elbow without the use of a compression garment.

After

Case 7

Vascularized Lymph Node Flap Transfer - Before Treatment photo, 59-year-old patient with grade II breast cancer-related lymphedema

Preop

A 59-year-old patient with grade II breast cancer-related lymphedema of the left upper extremity for 18 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was received non-vascularized lymph node transfer by other doctor on left elbow, and refractory to conservative decongestive therapy.

Before

3 Months

At the 3-months follow-up, the reduction rate was 10% above the elbow and 23% below the elbow without the use of a compression garment.

After

10 Months

At the 10-months follow-up, the reduction rate was 20% above the elbow and 30% below the elbow without the use of a compression garment.

After

20 Months

The skin paddle in the middle forearm was de-epithelialized and the left upper medial arm was subjected to liposuction at 14 months. At the 20-months follow-up, the reduction rate was 100% above the elbow and 42% below the elbow without the use of a compression garment.

After

Case 8

Vascularized Lymph Node Flap Transfer - Before Treatment photo, 46-year-old female

Preop

This is a 46-year-old female who had suffered from breast cancer-related lymphedema of the right upper extremity for 2 years after mastectomy, axillary lymph node dissection, and radiotherapy. She developed one episode of cellulitis per year with the use of compression garments.

Before

3 Months

At 3- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 20% and 15% above and below the elbow, respectively.

After

24 Months

At 24- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 37% and 20% above and below the elbow, respectively.

After

38 Months

At 38- month follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 40% and 25% above and below the elbow, respectively.

After

70 Months

At 70- month follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 75% and 50% above and below the elbow, respectively.

After

Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs

Case 1

Preop

A 65-year-old female with grade IV left lower limb lymphedema for 3 years after cervical cancer and radiation.

Before

3 Months

At the 3 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 30% above the knee and 40% below the knee without the use of a compression garment.

After

9 Months

At the 9 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 10% above the knee and 85% below the knee without the use of a compression garment.

After

Case 2

Preop

A 67-year-old female with grade IV right lower limb lymphedema for 8 years after cervical cancer and radiation. She was refractory to conservative decongestive therapy.

Before

6 Months

At the 6 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 15% above the knee and 5% below the knee without the use of a compression garment.

After

67 Months

At the 67 months of follow-up, after flap revision and right lower limb liposuction. The circumferential reduction rate was 62% above the knee and 50% below the knee without the use of a compression garment.

After

Case 3

Preop

This is a 15-year-old patient with left lower limb congenital lymphedema for 2 years.

Before

24 Months

At the 24 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms. The circumferential reduction rate was 10% above the knee and 30% below the knee without the use of a compression garment.

After

2 weeks after flap revision

At the 36 months of follow-up, after flap revision. The circumferential reduction rate was 10% above the knee and 30% below the knee without the use of a compression garment.

After

Case 4

Preop

This is a 5-year-old patient with right lower limb congenital lymphedema for 2 years.

Before

15 Months

At the 15 months of follow-up, vascularized submental lymph node flap transfer to the right ankle had significantly improved the symptoms. The circumferential reduction rate was 20% above the knee and 15% below the knee without the use of a compression garment.

After

6 months after flap revision

At the 13 months of follow-up, after flap revision. The circumferential reduction rate was 25% above the knee and 20% below the knee without the use of a compression garment.

After

Case 5

Preop

This is a 40-year-old patient with left lower limb congenital lymphedema for 15 years.

Before

6 Months

At the 6 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms. The circumferential reduction rate was 5% above the knee and 23% below the knee without the use of a compression garment.

After

36 Months

At the 36 months of follow-up, after flap revision and left lower limb liposuction. The circumferential reduction rate was 55% above the knee and 56% below the knee without the use of a compression garment.

After

Case 6

Preop

This is a 52-year-old female with grade II left lower limb lymphedema and grade I right lower limb lymphedema for 5 years after cervical cancer and radiation.

Before

1 Month

At the 1 month of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms and extremity tightness. right lower limb was received lymphaticovenous anastomosis without the use of a compression garment.

After

19 Months

At the 19 months of follow-up, vascularized submental lymph node flap transfer to the left ankle had significantly improved the symptoms and extremity tightness. right lower limb was received lymphaticovenous anastomosis without the use of a compression garment.

After

Treatment of Moderate to Severe Lymphedema

Vascularized Lymph Node Flap Transfer (VLNT) - Upper Limbs

Vascularized Lymph Node Flap Transfer (VLNT) - Lower Limbs

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