Carl, H.M., Walia, G., Bello, R., Clarke-Pearson, E., Hassanein, A.H., Cho, B., . . . Sacks, J.M. (2017). Systematic review of the surgical treatment of extremity lymphedema. Journal of Reconstructive Microsurgery. Advance online publication.
DOI Link
Purpose
STUDY PURPOSE: To examine the results of various surgical treatment for lymphema
TYPE OF STUDY: Systematic review
Search Strategy
Literature Evaluated
Sample Characteristics
- FINAL NUMBER STUDIES INCLUDED = 69 studies met inclusion criteria.
- TOTAL PATIENTS INCLUDED IN REVIEW = Not provided
- SAMPLE RANGE ACROSS STUDIES: Not provided
Phase of Care and Clinical Applications
PHASE OF CARE: Not specified or not applicable
Results
- Five studies involving excisional procedures, including 76 patients reporting limb volume reduction ranging from 16%–52%; four of the five studies reported multiple complications from the procedures.
- Four studies, including 105 patients with lower or upper extremity lymphedema reporting the effects of liposuction procedures; the weighted average percent of volume reduction was 96.63%.
- Lymphatic reconstruction procedures reported a weighted average for limb reduction of 5.8%. Lymphaticovenous anastomosis results were reported in 12 studies.
- Ten studies reported results from 185 patients who had tissue transfer procedures. For these, the weighted average limb reduction based on circumference was 39.5%.
- Eight studies, including 135 patients reporting the use of multiple surgical approaches; the combinations of techniques were varied.
- Studies varied regarding continued use of compression garments and physiotherapy postoperatively.
- Based on the results of this review, the authors provided an algorithm for decision making in the application of various surgical techniques.
Conclusions
The findings suggest that various surgical techniques can be effective to reduce limb volume; however, the research has several limitations. Relatively few studies examine each specific technique, and little evidence comparing these techniques to outcomes with other interventions known to be effective exists.
Limitations
- High heterogeneity
- Low sample sizes
- Varied methods of measuring lymphedema
Nursing Implications
A variety of surgical techniques and microsurgical procedures are being evaluated for their effects on the development of lymphedema. Currently, limited evidence supports any particular procedure or technique. Nurses should be aware of any potential long-term side effects of such procedures as this information becomes available.