Current status of lymphatic reconstructive surgery for chronic lymphedema: it is still an uphill battle!

The goal of reconstructive lymphatic surgery is to restore normal lymphatic function to "cure" permanently the lymphedematous limb in patients with lymphedema. In reality, reconstructive surgery remains an adjunctive treatment at best, with its current indication being refractory lymphedema in patients treated with complex decongestive therapy (CDT) alone. The role of reconstructive lymphatic surgery remains controversial and is far from being accepted as standard independent therapy because of multiple reasons. However, reconstructive surgery appears to be most effective in controlling the progression of lymphedema during the early stages when the paralyzed lymph vessels are still able to function and recover. Our experience in reconstructive surgery has shown that improved long-term results are dependent on prolonged patient compliance with maintenance CDT and the prevention and treatment of infection. To better understand the role of reconstructive surgery in the management of chronic lymphedema, well-constructed clinical trials based on well-organized multicenter studies with similar protocols are mandated. For the future, it remains the only possible treatment method capable of providing a cure.