Longitudinal evaluation of lymphatic reconstruction: Ten-year practice and outcome data from a single institution.

Abstract

Lymphedema (LE) is a chronic condition, caused by a lymphatic system dysfunction, with no definitive cure. Conservative treatment is the standard of care, but lymphatic reconstructive surgery has demonstrated promising results. After performing the first lymphatic surgery procedure in Switzerland in 2015, we conducted a retrospective cohort study evaluating 10 years of lymphatic reconstruction performed at the Department of Plastic Surgery and Hand Surgery at the University Hospital Zurich between 2015 and 2024. During this time, the key changes in techniques included a shift from predominantly lymphovenous anastomosis (LVA) to vascularized lymphatic tissue transfer (VLNT) alone or in variable combinations of LVA, lymph node-vein (LN-vein), VLNT, and liposuction. Outpatient consultations and surgeries increased markedly over the study period. The donor site shifted from axilla/groin to omentum as the standard VLNT donor site, enabling greater lymph node availability and dual-site transplantation. Approaches for primary and secondary LE were refined. Patients were analysed for volume reduction, complications and erysipelas improvement at the one-year follow-up. Limb volumes were assessed at standardized intervals using manual measurements. Overall, 61% of lower and 83% of upper extremities showed volume reduction, with 30% of patients reducing or discontinuing compression garments. In particular, erysipelas was significantly reduced by 87%. These results underscore the growing demand for lymphatic reconstructive surgery and evolving techniques over the past decade. Our findings support microsurgical treatment as an effective option to treat this complex condition.