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. SUMMARY BACKGROUND DATA 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 five 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 to the CDT group.