Letter to the Editor
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2025; 13(12): 98825
Published online Apr 26, 2025. doi: 10.12998/wjcc.v13.i12.98825
Enhancing outcomes in severe lymphedema through combined treatment strategies
Aidan Shulkin, Johnny I Efanov
Aidan Shulkin, Johnny I Efanov, Plastic and Reconstructive Surgery, Department of Surgery, Centre hospitalier de l’Université de Montréal, Montreal H2X3E4, Quebec, Canada
Author contributions: Shulkin A generated conceptualization, designed the study, and also contributed to the acquisition of data and its initial analysis; Efanov JI oversaw the entire project, ensured the accuracy of the analysis, and provided final approval of the version to be published; and all authors drafted the manuscript and revised it critically.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Johnny I Efanov, Associate Professor, MD, PhD, Plastic and Reconstructive Surgery, Department of Surgery, Centre hospitalier de l’Université de Montréal, 1051 Rue Sanguinet, Montreal H2X3E4, Quebec, Canada. johnny.ionut.efanov@umontreal.ca
Received: July 6, 2024
Revised: November 19, 2024
Accepted: December 17, 2024
Published online: April 26, 2025
Processing time: 184 Days and 14.3 Hours
Abstract

Lymphedema, particularly in its advanced stages, presents significant challenges in treatment, often necessitating a combination of therapies to manage symptoms effectively and improve patient outcomes. This article reviews the findings of Wang et al, regarding the use of lymphovenous anastomosis and complex decongestive therapy in treating severe, deformed stage III lymphedema with recurrent infections. The case report details the promising results achieved through this combined therapy, highlighting substantial reductions in limb volume and the complete resolution of recurrent lymphangitis. The patient experienced notable improvements in weight loss, physical function, and quality of life. Despite its strengths, the study has several limitations. It lacks specific details on the types of lymphovenous anastomoses performed and complex decongestive therapy protocols, such as frequency and adherence, making reproducibility difficult. The short follow-up period of six months limits understanding of long-term efficacy, and more consistent reporting of key metrics such as weight loss and body mass index would enhance outcome assessments. This article emphasizes the importance of integrating minimally invasive surgical techniques with conservative therapies to address both the symptoms and underlying causes of lymphedema. Further research is essential to standardize protocols and refine combined treatment strategies.

Keywords: Lymphedema; Lymphangitis; Lymphovenous anastomosis; Complex decongestive therapy; Quality of life; Mobility

Core Tip: This article highlights the effectiveness of combined therapy, particularly complex decongestive therapy and lymphovenous anastomosis, in treating severe deformed lymphedema, as demonstrated in a case report by Wang et al. The patient achieved significant improvements without reductive surgery, underscoring the potential of integrating conservative and minimally invasive treatments. The report emphasizes the need for continued research to optimize and standardize combined treatment protocols, considering both the benefits and limitations of current therapeutic approaches.