Introduction: Lymphoedema is caused by an abnormal increase in protein-rich interstitial fluid as a result of a lymphatic circulation disorder. This accumulation causes an increase in the circumference of the affected limb, restricting its mobility and reducing patient’s quality of life. The reference treatment consists of conservative measures, based on complex decongestive physiotherapy of the affected limbs, which consists of a combined program, which includes different approaches, like manual lymphatic drainage, compression therapy, physical exercise, strict skin care and patient education on hygiene- and dietary measures. These therapies slows down the progression of lymphoedema and reduce the volume of the affected limbs in the initial stages, but are not curative.
During the past years, there have been significant advances in the surgical techniques, and microsurgery is being considered as a possible alternative to conventional approaches. This assessment report was carried out at the request of the National Health System Interterritorial Council’s Services, Insurance & Finance Committee, in response to a proposal from the Andalusian Regional Health Authority, to support decision making regarding their inclusion in the National Health System service portfolio. Microsurgery of lymphoedema is not available in all of Spain’s Autonomous Regions (Comunidades Autónomas).

 Objective: The main aims are: 1) to analyse the safety, effectiveness and efficacy of microsurgical reconstructive techniques in secondary lymphoedema among patients who do not respond to conservative treatment; and, 2) to assess the effectiveness of microsurgery of lymphoedema versus conservative treatment. The secondary aim was to analyse the organisational aspects and costs of microsurgery of lymphoedema.

 Methods: To achieve the above goals, we conducted a systematic review of the literature. A specific search strategy was designed for each of the following sources of information: we reviewed leading biomedical databases, i.e., Centre for Reviews and Dissemination (CRD), Cochrane Library, Medline (Pubmed), Embase (OVID), ISI Web of Science and Scopus (SciVerse), and the databases of ongoing clinical trials (WHO International Clinical Trials Registry Platform and the US National Institutes of Health), using descriptors (MesH, Thesaurus, etc.) and adding free-text terms to address possible flaws in the indexing of some papers. The process was completed by a search using meta-search engines such as Google Scholar and the web pages of organisations and national assessment agencies. Papers were selected in accordance with a series of pre-defined selection criteria and then summarised in evidence tables. We only included prospective studies published from the year 2000 onwards.

Results, discussion and conclusion: See pdf below