Advanced Lymphedema Surgery
Dr. Granzow is a Board Certified Plastic Surgeon who performs advanced lymphedema surgery including microsurgical lymph node transfer, lymphaticovenous anastomosis, specialized lymphedema liposuction, and other surgical techniques for the treatment of lymphedema. He is the only surgeon who performs all of these major types of lymphedema surgery.
Dr. Granzow was asked to chair the panel on Lymphedema Surgery at the 2011 Annual Meeting of the American Society of Reconstructive Microsurgery (ASRM). This meeting is the largest annual meeting of microsurgeons in the world. |
 |
| Dr. Granzow on the panel on Lymphedema Surgery at the 2011 ASRM Meeting |
|
Tel: (310) 882-6261
|
|
About Lymphedema Surgery
Lymphedema has different presentations which require different types of surgical and non-surgical treatment. There is no single method of treatment which will address all types of lymphedema.
This website is dedicated to providing surgical options as a long term solution for patients with lymphedema. Dr. Granzow performs these surgeries in California in the Los Angeles area in private hospitals.
It is important to note that Dr. Granzow has dedicated significant amounts of time to research and investigation of surgical techniques for lymphedema treatment. He actively maintains memberships in organizations and societies which promote the safe and effective treatment of lymphedema. He not only routinely corresponds with recognized leaders in the field of lymphedema treatment in the United States and throughout the world, but also has spent time with them in their institutions learing the latest techniques and therapies.
Most recently, Dr. Granzow was the chair of the panel on lymphedema surgery at the latest meeting of the American Society of Reconstructive Microsurgeons, the premier organization of microsurgeons in the world.
It is critical that any surgeon chosen to perform lymphedema surgery keeps up with the latest research and developments achieved by multiple authorities. You must specifically ask your surgeon about their knowledge and affiliations to confirm that they have trained with all of the different leaders in the field.
Lymphedema Surgical Treatment Options
Multiple different and effective surgical treatments now exist for lymphedema, and each must be chosen specifically for the proper patient. Some procedures, like vascularized lymph node transfers, are relatively new. Other procedures, such as lymphaticovenous anastomoses, have been described previously and have been modified in recent years to yield better results.
The choice of technique for each patient is critical, and no one type of technique will fit each individual's condition. For example, lymph node transfers, even if properly performed by a trained surgeon, carry the risk of new onset lymphedema at the donor extremity, especially if taken from the axilla (armpit) to be placed in another location of the body. Lymphedema liposuction, which is different from standard liposuction, may be required if significant amount of fat and protein are present in an affected arm or leg.
Dr. Granzow has studied multiple types of surgical techniques with the leaders in the field to best recommend the procedure which will maximize the benefit while minimizing the risk of surgery. He works closely with trained lymphedema therapists to maximize the overall outcome.
These techniques are performed only by a small handful of highly specialized surgeons worldwide. Dr. Granzow is a pioneer in this area and works with colleagues from around the world continually to further refine these procedures. As a faculty mamber in the prestigious UCLA Division of Plastic Surgery he actively teaches residents, fellows and students in his role as Assistant Chief of Plastic Surgery at Harbor-UCLA Medical Center.
All lymphedema surgical procedures are performed personally by Dr. Granzow in private hospitals employing personalized service and the highest standards of medical care.
Safety of Lymphedema Surgery
Dr. Granzow practices only the newest and most modern surgical techniques to treat lymphedema. These modern surgeries are completely different from the previously disfiguring procedures which were performed by other doctors in the past. He has gone to great lengths to incorporate the highest levels of safety into his modern techniques. To date, none of his lymphedema surgery patients have had their lymphedema worsen from the surgery or begin at a lymph node donor site.
Vascularized Lymph Node Transfer (VLNT)
Vascularized lymph node transfers have been shown to be an effective method for the treatment of lymphedema of the arm. Lymph nodes are taken from the groin area with their supporting blood vessels and moved to a new location in the axilla (armpit). Dr. Granzow then uses specialized microsurgical techniques to reconnect the blood vessels to new vessels in the armpit to provide vital support to the transferred lymph nodes while they heal in the new area.
The transferred lymph nodes then serve as a filter or conduit to remove the excess lymphatic fluid from the arm and return it to the body's natural circulation.
This method of lymph node transfer often is performed together with a DIEP flap breast reconstruction. The combined procedure allows for both the simultaneous treatment of the arm lymphedema and the creation of a breast in one surgery. The DIEP flap reconstruction provides the opportunity for a beautiful and natural appearing reconstructed breast combined with contouring of the abdomen which is very similar to a tummy tuck. The lymph node transfer portion of the surgery removes the excess lymphatic fluid to return form, softness, and function to the arm. Patients must have excess fluid in the arm or leg with pitting lymphedema to be candidates for this procedure.
In some cases, the groin lymph nodes may be transferred as a group with their supporting artery and vein but without the additional tissue from the abdomen for breast reconstruction.
Click here for more information about vascularized lymph node transfer surgery (VLNT)
Lymphaticovenous Anastomosis (LVA)
Lymphaticovenous anastomosis involves the use of supermicrosurgery to join lymphatic channels in the affected area directly to nearby veins. The lymphatics are quite small, typically approximately 0.1 mm to 0.3 mm in diameter. The procedure employs specialized techniques and superfine surgical suture sewn with the aid of an adapted high power microscope.
The procedure can be an effective and long-term solution for extremity lymphedema. Patients must have excess fluid in the arm or leg with pitting lymphedema to be candidates for this procedure. After the procedure, most patients no longer require the use of their compression garments. In our experience patients have results which range from a moderate improvement in extremity circumference to an almost complete resolution of the problem.
LVA is the least invasive of the modern lymphedema procedures. Most patients can return home the day of their procedure.
Click here for more information about lymphaticovenous anastomoses (LVA)
Lymphatic Liposuction
Liposuction can be performed for lymphedema treatment. It must be emphasized that the lymphedema liposuction technique is NOT the standard cosmetic liposuction technique and should be performed using specific parameters, methods and protocols, many of which have been delevoped and studied by Dr. Hakan Brorson in Malmo, Sweden. Specific training in this method is required, and Dr. Granzow has taken this training in Sweden with Dr. Brorson. Patients are candidates if the swelling in the limb is due to deposition of fat, protein and fibrotic tissue with non-pitting edema.
Published studies indicate a long term and reproducible reduction in the size of the affected arm or leg.
Important limitations of this technique are the requirement of lifelong compression garment and sleeve therapy after surgery at this time. Again, specialized training of the surgeon specifically in this technique is critical. We do not recommend liposuction of lymphedema limbs by surgeons who have not been specifically trained in the lymphedema liposuction technique.
Click here for more information about specialized lymphatic liposuction
|
