Plastic Surgery Research Council

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Surgical Lymphedema Treatment Increases Quality of Life
Halley Darrach, BS, George Kokosis, MD, Hannah M. Carl, BS, Kelly Bridgham, BS, Michelle Seu, BS, Gurjot Walia, BS, Justin M. Sacks, MD, MBA.
Johns Hopkins School of Medicine, BALTIMORE, MD, USA.

Lymphedema is a chronic, progressive condition that can have a profound impact on physical and psychological quality of life (QoL). Early lymphedema is commonly managed with complete decongestive therapy (CDT) while severe cases are treated surgically; options include liposuction, excision, lymphovenous bypass, or lymph node transfer. A majority of current research relies solely on volumetric analysis to determine treatment success. However, these measurements do not convey changes in the patients' QoL. Our objective was to examine change in quality of life for patients undergoing surgical lymphedema treatment using two validated, health-related QoL instruments: the RAND-36 and the lymphedema-specific LyQLI.
In this IRB-approved longitudinal cohort study, patients were recruited from a multidisciplinary lymphedema center if they were referred for lymphedema surgery. All patients received baseline RAND-36 and LyQLI, while those electing to undergo surgical lymphedema management were also surveyed at 3 and 6 months postoperatively. Outcomes were assessed using paired and unpaired t-tests where appropriate.
29 patients were recruited with a mean age of 55 years and mean disease duration of 13.5 years. All patients had pursued CDT for at least 3 years prior to consultation and 75% had ISL stage 2 disease. Half of the cases occurred in the upper vs. lower extremities and half were due to primary vs. secondary causes. As of October 2018, 16 patients underwent surgery (6% liposuction, 12% excision, 44% bypass, and 38% transfer) with a mean follow-up time of 2.8 months. There was no significant difference in demographics or comorbidities between those electing to undergo surgery and not.
Patients undergoing surgery witnessed decreased impairment in all LyQLI domains and increased overall health, which trended towards significance. Those with 6-month follow-up also indicated their lymphedema had little or no practical or psychosocial limitations (indicated by LyQLI scores <50). The RAND-36 did not reveal any significant differences, though surgical patients exhibited steady improvement in pain and emotional problems.
Though our study is ongoing and thus results are restricted due to limited postoperative follow-up, these data indicate that surgical intervention can, within 6 months, produce improved QoL in patients with long-standing lymphedema. Further surveying will be required to differentiate any possible differences between operative method to better inform surgical decision-making.

LyQLI results: N= 13 non-operative patients and n=17 surgical patients (5 with 6-month follow-up and 8 with 3-month follow-up). For physical, psychosocial, and practical domains a mean score <50 indicates none or little impact of lymphedema on QoL and a score of ≥50 as having a substantial impact. Overall health is graded as 0 being the lowest possible QoL and 100 being highest.

RAND-36 results: All domains are graded as 0 being the greatest impact on QoL and 100 being no impact.

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