Vascularized lymph node transfer (VLNT) and lymphovenous anastomosis (LVA) are established methods in reconstructive lymphedema surgery. As a possible option for therapy, they should always be considered with the patient. For their preparation, functional lymphoscintigraphy and sonography of the lymph vessels are indispensable. The postoperative results of VLNTs are encouraging: 100% of patients reported a subjective improvement, 91% of cases had a volume reduction, and 78% of patients were able to forego compression therapy. After VLNT, activity of the transplanted lymph nodes could be detected in 31% of the subjects. Despite all potential risks, VLNT is a solid option in the surgical therapy of lymphedema. Especially in cases of severe sclerosis of the lymph vessels and the associated insufficient pump function, it is superior to LVAs, though because of higher complication rates with sometimes severe consequences for patients, the indication for it should be considered carefully.