Tweets from the BLS (1) – Learning curve for lymphatic microsurgery

@Oxford OLP

Oct 5

At ‪#bsl‬‬‬‬‬ meeting in Birmingham.

Great session on surgery for ‪#lymphedema‬‬‬‬‬

Boccardo: learning curve for lymphatic microsurgery around 30 cases ‪#lymphedema‬‬‬‬‬ ‪#BLS2014‬‬‬‬‬

Boccardo: Lymphatic microsurgery can cure early ‪#lymphedema‬‬‬‬‬ ‪#screening‬‬‬‬‬

Following on from my tweets reporting on the latest developments in lymphoedema and its treatment from the European Society of Lymphology meeting in Genoa, I will present a series of tweets sent from the British Lymphology Society meeting in Birmingham in October. This was again an excellent meeting, well attended by lymphoedema practitioners, but with a good sprinkling of physicians and surgeons, representing the renaissance of medical interest in lymphoedema in the last few years, as we realize that we finally have at our disposal treatments that work.

One of these modern surgical treatments for lymphoedema is microsurgery (see my previous posts). Microsurgery is technically demanding. As Plastic Surgeons, we are used to transferring tissue around the body using microsurgery (e.g. DIEP flaps for breast reconstruction). These operations are called “free flaps”. They involve joining together blood vessels around 1-2mm in diameter. Their success rate is very high, usually over 98%.

Microsurgery for lymphoedema (Lymphaticovenular anastomosis – LVA) is the next level. Here, we connect together lymphatics and venules on average 0.3-0.8 mm in diameter, using stitches that are around 1/5 the diameter of a human hair. This requires excellent technical skill, and also experience.

This point was highlighted by Francesco Boccardo from Genoa at the BLS meeting. He reviewed all of his cases where he has used microsurgery to prevent lymphoedema after removal of the lymph glands from the armpit in breast cancer. He found that all three of his failures were within his first 30 cases, with none in the subsequent 40+ cases. He felt this meant the learning curve for microsurgery is around 30 cases. As I reported previously, the success of LVA depends on the number of anastomoses performed and the quality of these anastomoses, so it is vital that LVA is performed by an experienced surgical team, with more than one surgeon operating at the same time. With this combination, early lymphoedema might be cured by microsurgery.

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  • This sounds really exciting . my lymphoedema arm is mild/moderate and I can manage with a Class 1 sleeve, exercise and massage, but it would have been even better if it could have been prevented!

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