Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
Send us all your questions or requests, and our expert team will assist you.
Physiological lymphedema surgeries (LVA, VLNT) demand high-precision setups. General anesthesia is typically used to ensure absolute immobility. The operating room is equipped with high-powered microscopes capable of 20-40x magnification.
For LVA, local anesthesia with sedation can sometimes be used. The patient’s limb is prepped and draped to allow access to multiple incision sites. Specialized “super-microsurgery” instruments, with tips finer than a needle, are prepared for manipulating vessels as small as 0.3mm.
For Lymphaticovenular Anastomosis (LVA), the surgeon makes small (2-3 cm) incisions at the ICG-mapped sites. Using the microscope, they locate a functional lymphatic vessel and a nearby venule.
The lymphatic vessel is sutured into the vein using threads thinner than a human eyelash. This creates a shunt, allowing lymph fluid to flow directly into the bloodstream, bypassing the blockage. Multiple bypasses (3-5) are typically performed on a single limb to maximize drainage.
For Vascularized Lymph Node Transfer (VLNT), the surgeon harvests a flap of tissue containing lymph nodes and their blood supply from the donor site. The flap is carefully dissected to protect the nodes.
The flap is transferred to the recipient site (e.g., wrist or ankle). The surgeon connects the flap’s artery and vein to blood vessels in the limb using microsurgery. This restores blood flow to the nodes, keeping them alive. The skin is then closed over the flap.
Suction-Assisted Protein Lipectomy (SAPL) is performed under general anesthesia. A tourniquet may be used to minimize bleeding. The surgeon uses power-assisted liposuction cannulas to break up and remove the dense, fibrotic fat.
The procedure is aggressive, aiming to remove as much excess tissue as possible to match the healthy limb’s size. It is performed circumferentially around the limb. While it removes tissue, great care is taken to avoid damaging the remaining longitudinal lymphatic vessels.
In the rare Charles procedure, the surgeon excises all skin and subcutaneous tissue down to the deep fascia. The healthy skin harvested from the excised tissue (or from a donor site) is then used as a split-thickness graft to cover the muscle fascia.
This is a major debulking surgery. Drains are placed, and the limb is heavily bandaged. It effectively “resets” the limb volume but leaves a grafted appearance.
For free flaps (VLNT), monitoring is intensive. The flap is checked hourly for color and temperature to ensure blood flow. LVA patients require less intensive monitoring but must elevate the limb.
For SAPL, monitoring focuses on fluid balance and blood loss, as significant volume shifts can occur. The limb is immediately wrapped in compressive bandages to prevent rapid fluid reaccumulation.
Drains are common in VLNT and SAPL to remove excess fluid and blood. They prevent hematoma and seroma formation. In SAPL, drains may stay in for days until the output decreases.
Dressings are designed to apply even pressure. LVA incisions are covered with small waterproof dressings. VLNT sites have a window for monitoring the flap. SAPL limbs are wrapped in multi-layer compression bandages from toes to groin/axilla.
For free flaps (VLNT), monitoring is intensive. The flap is checked hourly for color and temperature to ensure blood flow. LVA patients require less intensive monitoring but must elevate the limb.
For SAPL, monitoring focuses on fluid balance and blood loss, as significant volume shifts can occur. The limb is immediately wrapped in compressive bandages to prevent rapid fluid reaccumulation.
Pain varies by procedure. LVA is minimally painful. VLNT involves a donor site and a recipient site, requiring moderate pain control. SAPL can cause soreness and bruising similar to a heavy workout or extensive bruising.
Multimodal pain management is used, including narcotics for the first few days, transitioning to anti-inflammatories and Tylenol. Elevation significantly reduces throbbing pain.
LVA patients often go home the same day. VLNT patients stay 2-4 days for flap monitoring. SAPL patients may stay overnight for observation or go home if stable.
Discharge instructions focus on limb protection. No blood pressure cuffs or needle sticks are allowed on the operated limb. Patients are taught how to check their incisions and manage their drains if sent home with them.
Gentle movement is encouraged to prevent blood clots (DVT). However, strenuous activity is restricted. For VLNT, the limb may be splinted for a few days to protect the micro-connections.
For SAPL, movement helps pump fluid out, but the heavy bandages limit the range of motion. Patients are encouraged to walk but keep the limb elevated when resting.
Due to a compromised lymphatic system, the risk of infection is higher. Patients typically receive IV antibiotics during surgery and oral antibiotics for one or more weeks afterward. This prevents cellulitis from attacking the healing tissues.
Preventing infection is critical, as a single episode can scar the new lymphatic connections (LVA/VLNT) or damage the skin grafts.
Send us all your questions or requests, and our expert team will assist you.
LVA is very low pain. VLNT causes moderate discomfort at the donor site (like a pulled muscle) and the incision site. SAPL feels like deep bruising and soreness. Pain is usually well-managed with medication and elevation.
Flap failure is rare (1-3%). We monitor it closely in the hospital. If blood flow stops, we take you back to surgery to fix the vessel. If the flap dies, it must be removed, but this does not worsen your original lymphedema.
Drains are usually removed when the fluid coming out is less than 30ml per day. This typically takes 3 to 7 days for VLNT and SAPL. LVA usually does not require drains.
Yes, you can walk short distances (to the bathroom, around the house) immediately. However, you must keep your leg elevated whenever you are sitting or lying down to help the fluid drain and reduce swelling.
Compression is vital after SAPL and VLNT. It prevents the limb from refilling with fluid. Without tight bandages, the space we created by removing fat would fill with lymph fluid, ruining the surgery.
Your Comparison List (you must select at least 2 packages)
