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[36] Previous studies have demonstrated that best results can be achieved, when surgery is performed as a part of comprehensive treatment incorporating individualized CDT before and after surgery [71-73] Modern lymphedema surgeries such as vascularized lymph node transfer (VLNT), lymphaticovenous anastomosis (LVA), lymphoticolymphatic bypass (LB), and suction-assisted protein lipectomy (SAPL) are less invasive than previous radical excisional debulking procedures, such as Charles procedure, which involves aggressive removal of the skin and deeper tissues.
Of note, LVA and VLNT best address the fluid portion of swelling which typically is more prevalent during the early stages of lymphedema.
VLNT is an increasingly practiced micro-surgical procedure for patients with lymphedema, in which an auxiliary lymph node is autologously transplanted as a tissue flap to the treatment area.