Once your appointment has been confirmed, our coordinator at the A+ Surgery Clinic will provide you with an estimated range for your medical expenses.
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Based on Cheng’s Lymphedema Grading (CLG) System and Taiwan Lymphoscintigraphy Staging System of the severity of regional lymphatic obstruction, either lymphovenous anastomosis (LVA) or vascularized submental lymph nodes (VSLN) flap transfer will be chosen to be performed on your affected limb(s) to solve the lymphatic problem. We will schedule your initial consultation with Dr. Cheng once your travel itinerary to Taiwan is confirmed. Dr. Cheng will explain to you the diagnosis based on the severity grading, treatment selections, suggested operation, and expectations of surgical outcomes in detail once your evaluation results are being fully reviewed. Your operation will be scheduled right away with your consent without any extra waiting time. You will receive the pre-operation consultation, evaluation exams, operation, and rehabilitation all on the same trip.
LVA is an advanced minimally- invasive super-microsurgery procedure that can effectively relieve the symptoms of early-grade (CLGI- II) lymphedema. If the LVA is chosen for your treatment, Dr. Cheng will perform 1 or 2 Side-To-End (lymph-to-vein) anastomoses on the affected limb to allow lymph to drain into the subdermal veins from both proximal and distal directions.
VSLN flap transfer is a procedure for patients who have moderate to severe (CLG II-IV) lymphedema. The choice of VSLN flap is based on the patient’s preference for the donor site and the availability of sizable lymph nodes assessed by preoperative ultrasonography and MRI. The vascularized submental lymph node (VSLN) flap is the most commonly chosen lymph node flap by Dr. Cheng and his patients. The VSLN flap is transferred to a distal recipient site – dorsal wrist in the upper extremity or ankle in the lower extremity by the “pump” mechanism, catchment effect, and natural gravity effect to achieve the maximal functional recovery. The unsightly skin on the dorsal wrist or ankle can be excised to form a linear scar one year after the VSLN flap transfer as the lymphedematous limb will then become softer, lighter, and smaller.
There is a chance that complications (vascular thrombosis) may occur after the VSLN flap transfer, depending on patients’ body constitution, usually the immune system, or predisposing risk factors such as anticoagulant exposures, or even reactions to certain medications. Should any complications occur, the transferred flap would need a re-exploration surgery to solve the vascular insufficiency. If immune reactions cause vascular thrombosis after the operation, the last-line medication of human immunoglobulin (IVIG) will be used to remove the antibodies.
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