Physiologic Surgery of Lymphedema (Overall Description of All Procedures, Including LVB, LNF, and VLNT)

Surgical treatment options for lymphedema have greatly advanced beyond ablative options in recent decades. Physiologic surgeries aim to reduce lymph accumulation by addressing the imbalanced drainage at the root of lymphedema pathophysiology. These procedures use refined microsurgery techniques to reroute lymphatic fluid from obstructed lymphatic vessels into the venous system through lymphaticovenular anastomosis or to incorporate functional lymph nodes into a region of prior nodal dissection through vascularized lymph node transplant. In this chapter, we provide an overview of the various physiologic techniques available, key technical considerations, and the indications for each procedure based on individual patient staging and disease severity. We discuss the common donor sites for lymph node flaps, including selection criteria and benefits/limitations of each harvest site.