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Purpose <p>Inguinofemoral lymphadenectomy is associated with a high risk of lymphorrhea, seroma formation and lower limb lymphedema. Performing multiple lymphatic-venous anastomoses after lymph node dissection has shown potential in reducing this risk. The lymphatic microsurgical preventive healing approach (LYMPHA) aims to prevent lymphedema by establishing alternate lymphatic drainage pathways immediately following lymphadenectomy.</p> Methods <p>Five patients with squamous cell carcinoma of the vulva requiring inguinofemoral lymph node dissection (IFLND) underwent the LYMPHA technique. After completion of groin dissection, lymphatic afferents were identified, and multiple lymphovenous anastomoses (MLVA) were performed with a collateral branch of the great saphenous vein. Each patient had 2–4 lymphatic vessels anastomosed per side. Patients were followed up every 3&#xa0;months, and data were collected for up to 15&#xa0;months.</p> Results <p>The LYMPHA technique was performed in 5 patients (10 groins). In eight groins, the procedure was successful, with a reduced average daily drain output (15&#xa0;ml versus 110&#xa0;ml) and drains being removed early in the postoperative period (days 10–12 versus day 30). No seromas developed after drain removal. In the follow-up period, lower limb circumferences remained stable in eight successful cases, and none of the patients developed lymphedema at 15-month follow-up. While a 25% and 30% increase was noted in the groins, where it was unsuccessful. Adjuvant treatment was required in two patients, and it was started without any delay.</p> Conclusions <p>Our experience suggests that the LYMPHA technique is a safe, feasible and effective method for preventing lymphedema following IFLND. It holds promise for improving patient outcomes, reducing healthcare costs and enhancing quality of life by minimizing postoperative complications without compromising the adequacy of surgery and not causing any delay in adjuvant treatment.</p>

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Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for Lymphedema Prevention Following Inguinofemoral Lymph Node Dissection in Vulvar Cancer—A Case Series

  • 期刊论文

  • 发表日期：

    2025年10月16日

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  • Deepika Sheoran,
  • Shruti Bhatia,
  • Himanshu Gupta,
  • Shubhi Yadav,
  • N Jagadish

摘要

Purpose

Inguinofemoral lymphadenectomy is associated with a high risk of lymphorrhea, seroma formation and lower limb lymphedema. Performing multiple lymphatic-venous anastomoses after lymph node dissection has shown potential in reducing this risk. The lymphatic microsurgical preventive healing approach (LYMPHA) aims to prevent lymphedema by establishing alternate lymphatic drainage pathways immediately following lymphadenectomy.

Methods

Five patients with squamous cell carcinoma of the vulva requiring inguinofemoral lymph node dissection (IFLND) underwent the LYMPHA technique. After completion of groin dissection, lymphatic afferents were identified, and multiple lymphovenous anastomoses (MLVA) were performed with a collateral branch of the great saphenous vein. Each patient had 2–4 lymphatic vessels anastomosed per side. Patients were followed up every 3 months, and data were collected for up to 15 months.

Results

The LYMPHA technique was performed in 5 patients (10 groins). In eight groins, the procedure was successful, with a reduced average daily drain output (15 ml versus 110 ml) and drains being removed early in the postoperative period (days 10–12 versus day 30). No seromas developed after drain removal. In the follow-up period, lower limb circumferences remained stable in eight successful cases, and none of the patients developed lymphedema at 15-month follow-up. While a 25% and 30% increase was noted in the groins, where it was unsuccessful. Adjuvant treatment was required in two patients, and it was started without any delay.

Conclusions

Our experience suggests that the LYMPHA technique is a safe, feasible and effective method for preventing lymphedema following IFLND. It holds promise for improving patient outcomes, reducing healthcare costs and enhancing quality of life by minimizing postoperative complications without compromising the adequacy of surgery and not causing any delay in adjuvant treatment.