{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:50:21Z","timestamp":1791366621091,"version":"4.3.1"},"reference-count":0,"publisher":"Georg Thieme Verlag KG","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"abstract":"<jats:p>Background \nComprehensive lymphedema programs (CLPs) have recently been established at several large academic medical centers. However, little has been published regarding implementation of multidisciplinary lymphedema programs serving predominantly rural and medically underserved populations. We describe our early experience developing a CLP and highlight lessons that may facilitate implementation in similar settings. \n\nMethods \nWe performed a retrospective review of all patients referred to our CLP from November 2021 to April 2024. Patients without complete electronic medical record information were excluded. Financial analyses were limited to patients who underwent operative intervention and completed all insurance preauthorization and appeal processes.  \n\nResults \nA total of 321 patients were referred to our CLP, of whom 190 underwent complete evaluation. Seventy-three patients (38.4%) underwent operative intervention, including 43 (58.9%) who underwent immediate lymphatic reconstruction (ILR). Among patients undergoing delayed lymphatic reconstruction (DLR), 60% underwent physiologic, and 26.7% underwent debulking procedures. The program demonstrated sustained growth throughout the study period with expansion into a multistate referral network. Insurance reimbursement remained limited, with insurers covering 29.7% of surgeon fees and total reimbursement averaging 35.7% of billed surgeon charges. \n\nConclusions \nDevelopment of a CLP serving a predominantly rural and medically underserved population region is feasible through multidisciplinary collaboration, strategic resource allocation, and adaptation to local resources. The principles described may provide a practical framework for developing sustainable comprehensive lymphedema programs and expanding access to specialized lymphedema care in similar settings.<\/jats:p>","DOI":"10.1055\/a-2972-6145","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T23:11:11Z","timestamp":1791241871000},"source":"Crossref","is-referenced-by-count":0,"title":["Establishing a Comprehensive Lymphedema Program in a Rural Region"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5454-114X","authenticated-orcid":false,"given":"Devin John","family":"Clegg","sequence":"additional","affiliation":[{"name":"The University of Tennessee Health Science Center College of Medicine- Knoxville, Tennessee, United States","place":["Knoxville"],"department":["Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Lock","sequence":"additional","affiliation":[{"name":"The University of Tennessee Health Science Center College of Medicine, Tennessee, United States","place":["Memphis"],"department":["College of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J","family":"Ward","sequence":"additional","affiliation":[{"name":"1. The University of Tennessee Health Science Center College of Medicine- Knoxville, Tennessee, United States","place":["Knoxville"],"department":["Surgery, Division of Surgical Oncology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payton","family":"Grande","sequence":"additional","affiliation":[{"name":"The University of Tennessee Health Science Center College of Medicine, Tennessee, United States","place":["Memphis"],"department":["College of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashton J","family":"Brooks","sequence":"additional","affiliation":[{"name":"1. The University of Tennessee Health Science Center College of Medicine- Knoxville, Tennessee, United States","place":["Knoxville"],"department":["Surgery, Division of Surgical Oncology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia NE","family":"Roberson","sequence":"additional","affiliation":[{"name":"1. The University of Tennessee Health Science Center College of Medicine- Knoxville, Tennessee, United States","place":["Knoxville"],"department":["Surgery"]},{"name":"The University of Tennessee Knoxville College of Nursing, Tennessee, United States","place":["Knoxville"],"department":["College of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jillian M","family":"Lloyd","sequence":"additional","affiliation":[{"name":"1. The University of Tennessee Health Science Center College of Medicine- Knoxville, Tennessee, United States","place":["Knoxville"],"department":["Surgery, Division of Surgical Oncology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanos","family":"Boukovalas","sequence":"additional","affiliation":[{"name":"1. The University of Tennessee Health Science Center College of Medicine- Knoxville, Tennessee, United States","place":["Knoxville"],"department":["Surgery, Division of Plastic & Reconstructive Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2972-6145.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:58:13Z","timestamp":1791363493000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2972-6145"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1055\/a-2972-6145","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10,5]]},"published":{"date-parts":[[2026,10,5]]}}}