{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:40:06Z","timestamp":1789494006460,"version":"build-2803163510"},"reference-count":20,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lymphatic Research and Biology"],"published-print":{"date-parts":[[2021,2,1]]},"abstract":"<jats:p>Physiologic surgical interventions, including lymphovenous bypass (LVB) and vascularized lymph node transplant (VLNT), are increasingly being used to treat lymphedema. LVB has been shown to be effective in improving the severity of lymphedema, particularly for patients with still-functional superficial lymphatic vessels that can be identified for bypass. However, in many patients, there is a paucity of functional lymphatic vessels for bypass and, thus, they are not ideal candidates for LVB alone. Unlike LVB, VLNT does not depend on the presence of functioning lymphatic vessels, but the effects of VLNT are delayed, as the proposed mechanisms of action require more time for optimal function. The author has offered a combined approach to microsurgical treatment of lymphedema for both the upper and lower extremities. Simultaneous VLNT and LVB are safe and effective for patients with both early and advanced stages of primary and secondary lymphedema. Our experience shows that a majority of patients can expect some long-term improvement, in both overall limb volume and quality of life, after surgical intervention with LVB and\/or VLNT.<\/jats:p>","DOI":"10.1089\/lrb.2020.0098","type":"journal-article","created":{"date-parts":[[2020,11,23]],"date-time":"2020-11-23T12:55:11Z","timestamp":1606136111000},"page":"23-24","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["Combined Approach to Surgical Treatment of Lymphedema"],"prefix":"10.1177","volume":"19","author":[{"given":"David W.","family":"Chang","sequence":"first","affiliation":[{"name":"Section of Plastic and Reconstructive Surgery, Department of Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, Illinois, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,2,24]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181f44658"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1359105315589801"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002683"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-011-2017-4"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181e5f6a9"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0038-1636510"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.25166"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3182a4d626"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2014.0022"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e318272a1b4"},{"key":"e_1_3_3_12_2","article-title":"An algorithmic approach to simultaneous vascularized lymph node transfer with microvascular breast reconstruction","volume":"22","author":"Ngyuen A","year":"2015","unstructured":"Ngyuen A, , Chang EI, , Sumai H, , Chang DW. An algorithmic approach to simultaneous vascularized lymph node transfer with microvascular breast reconstruction. Ann Surg Oncol, 2015; 22:2919\u20132124.","journal-title":"Ann Surg Oncol"},{"key":"e_1_3_3_13_2","first-page":"932","article-title":"Vascularized lymph node transfer and lymphovenous bypass: Novel treatment strategies for symptomatic lymphedema","author":"Silva AK","unstructured":"Silva AK, , Chang DW. Vascularized lymph node transfer and lymphovenous bypass: Novel treatment strategies for symptomatic lymphedema. J Surg Oncol \/2016;, 113:932\u2013939.","journal-title":"J Surg Oncol \/2016;"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24351"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24347"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24343"},{"key":"e_1_3_3_17_2","article-title":"Outcomes for physiologic microsurgical treatment of secondary lymphedema involving the extremity","author":"Beederman M","year":"2020","unstructured":"Beederman M, , Garza RM, , Agarwal S, , Chang DW. Outcomes for physiologic microsurgical treatment of secondary lymphedema involving the extremity. Ann Surg, 2020 [Epub ahead of print]; DOI: 10.1097\/SLA.0000000000004457.","journal-title":"Ann Surg"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2017.0007"},{"key":"e_1_3_3_19_2","doi-asserted-by":"crossref","unstructured":"Hassan K Chang DW. The Charles procedure as part of the modern armamentarium against lymphedema. Ann Plast Surg 2020.","DOI":"10.1097\/SAP.0000000000002263"},{"key":"e_1_3_3_20_2","article-title":"Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the prevention of secondary lymphedema","author":"Agarwal S","year":"2019","unstructured":"Agarwal S, , Garza RM, , Chang DW. Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the prevention of secondary lymphedema. Breast J, 2019 [Epub ahead of print]; DOI: 10.1111\/tbj.13667.","journal-title":"Breast J"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12609-020-00372-1"}],"container-title":["Lymphatic Research and Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/lrb.2020.0098","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/lrb.2020.0098","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/lrb.2020.0098","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T20:13:33Z","timestamp":1777666413000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/lrb.2020.0098"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,1]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,2,1]]}},"alternative-id":["10.1089\/lrb.2020.0098"],"URL":"https:\/\/doi.org\/10.1089\/lrb.2020.0098","relation":{},"ISSN":["1539-6851","1557-8585"],"issn-type":[{"value":"1539-6851","type":"print"},{"value":"1557-8585","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,1]]}}}