Added Value of Reconstructive Lymphatic Surgery to Usual Care in Lymphoedema

"Home physical therapist performs usual care and educates the patient to perform self-management~Usual care:~M1-6: 6 months of maintenance decongestive lymphatic therapy (DLT) (by patient and home physical therapist):~* week 1-2: no physical therapy; patient performs limb elevation, muscle contractions and wears the bandage (intervention group)/ compression garment (control group)~* week 3-4: start physical therapy, 2 days/ week: exercises, skin care \& manual lymph drainage (MLD), education; self-management by patient and wearing compression garment 14-16h/day (4 sessions) M2-6: 1 day/ week physical therapist: exercises, skin care \& MLD, and self-management by patient and wearing compression garment 14-16h/day (20 sessions)~M7-12: 6 months of maintenance DLT by patient (self-management) and home physical therapist:~\- 1 day/week physical therapist: skin care, MLD, exercises (26 sessions) Month 13-18: 6 months of maintenance DLT by patient Month 19-36: 18 months of follow-up"

"For the procedure of LVA:~\- Aim: making anastomoses of lymph vessels at the capillary level with a diameter of 0.3 to 0.8 mm, to redirect lymph to venous stream directly~For the procedure of LNT:~\- Aim:~1. Placed lymph nodes act as sponge to absorb lymphatic fluid and direct it into the vascular network;~2. Placed lymph nodes induce lymphangiogenesis"