Improvement of the Natural Progression of Extremity Lymphedema Treated With Lymphatic Microsurgery

Objective: To assess the effect of complete decongestive therapy (CDT) and lymphedema microsurgery (LM) on the natural progression of extremity lymphedema. Background: The natural progression of extremity lymphedema includes interstitial lymph accumulation, frequent cellulitis, adipose deposition, and fibrosis, which remain unexplored. Methods: Prospectively collected data of patients with extremity lymphedema managed with either CDT (61 patients) or LM (118 patients) with a follow-up of 2 years between November 2011 and September 2019 were analyzed. The primary outcomes included Taiwan lymphoscintigraphy staging (TLS) to assess lymphatic drainage; episodes of cellulitis for infection; limb circumferential and volumetric differences for adipogenesis; and tissue softness for fibrosis. The secondary outcome was a lymphedema-specific quality-of-life (LYMQOL) questionnaire. Results: At 1-year follow-up, the LM group demonstrated significant improvements in mean TLS (3.77 +/- 1.48 vs 2.67 +/- 1.33, P<0.0001), and volumetric difference (43.2 +/- 25.8% vs 31.7%+/- 21.7%, P=0.00025). Moreover, at 2-year follow-up, the LM group exhibited a significant reduction of episodes of cellulitis (2.39 +/- 2.05 vs 0.77 +/- 1.04, P<0.0001), circumferential difference (23.4 +/- 11.3% vs 14.3 +/- 11.0%, P<0.0001), and tissue-softness grade (2.41 +/- 1.15 vs 1.42 +/- 0.633, P<0.0001). Improvements were observed across all 5 LYMQOL domains at 1 and 2 years in patients with LM (all P<0.0001). No significant improvements in the primary or secondary outcomes were noted in the CDT group. Conclusions: The LM group had significantly increased lymphatic drainage, decreased episodes of cellulitis and adipogenesis, reduced fibrosis, and improved quality of life compared with the CDT group.