Surgical prevention and treatment of lymphedema after lymph node dissection in patients with cutaneous melanoma.

Despite the development of minimalaccess dissection techniques, use of superficialgroin dissection alone, and other recommendationsto reduce morbidity in melanomatreatment, the incidence of lymphedema is stillsignificant. The purpose of the current studywas to assess the efficacy of microsurgicalmethods to limit the morbidity of inguinallymphadenectomy. We conducted a retrospectivereview of patients who underwent groindissection for melanoma treatment fromFebruary 2006 to April 2009. A total of 59melanoma patients with positive groin lymphnodes comprised 18 patients (T-group) withmelanoma in the trunk and 41 patients(E-group) who had melanoma in an extremityand currently have lymphedema. The T-grouppatients underwent primary prevention oflymphedema with microsurgical lymphaticvenousanastomoses (LVA) performedsimultaneously with groin dissection. TheE-group patients underwent LVA to treat thesecondary lymphedema after an accurateoncological and lymphological assessment.Limb volume measurements and lymphoscintigraphywere performed pre- and postoperativelyto assess short and long termoutcome. No lymphedema occurred aftermicrosurgical primary preventive approachin the T- group. Significant (average 80%reduction of pre-op excess volume) reductionof lymphedema resulted after microsurgicaltreatment for secondary leg lymphedema.Post-operative lymphoscintigraphy in 35patients demonstrated patency of microsurgicalanastomoses in all cases with an averagefollow-up of 42 months. Study resultsdemonstrate that microsurgical LVA primaryprevention prevented lymphedema afteringuinal lymphadenectomy in the T-grouppatients. In addition, lymphatic-venousmultiple anastomoses proved to be a successfultreatment for clinical lymphedema withparticular success if treated at the early stages.