{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:56:10Z","timestamp":1775091370666,"version":"3.50.1"},"reference-count":46,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,1,24]],"date-time":"2022-01-24T00:00:00Z","timestamp":1642982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Bilateral lower extremity lymphedema is a rare and invalidating condition that poses a great challenge to the scientific community, and deeply affects the quality of life (QoL) of affected patients. A combined protocol consisting of lymph node transfer and a reductive method have never been reported for the treatment of this condition, except for small case series with brief follow-up periods. Methods: This retrospective study analyzed data of 29 patients, mean age 51 \u00b1 17.1 years, who had been diagnosed with bilateral lower extremity lymphedema. Gastroepiploic vascularized lymph node transfer was performed in all the patients, and an excisional procedure was associated according to the clinical stage. Clinical history, circumferential limb measurements, complications, episodes of cellulitis, and responses to the Lymphedema Quality of Life Questionnaire were analyzed. Results: The mean follow-up was 38.4 \u00b1 11.8 months. A significant reduction in the episodes of cellulitis per year was observed (p &lt; 0.001). In our series, BMI and duration of symptoms were significantly related to the development of cellulitis during the postoperative period, p = 0.006 and p = 0.020, respectively. The LYMQoL questionnaire showed a significant quality of life improvement from 3.4 \u00b1 0.9 to 6.2 \u00b1 0.8 (p &lt; 0.05). Conclusions: An integrated approach is essential for the treatment of bilateral lower extremity lymphedema: reductive and reconstructive methods are complementary to achieve a successful outcome. Timely treatment and BMI reduction are relevant in order to decrease the number of episodes of cellulitis. An attentive follow-up is necessary to identify recurrence and treat affected patients in time.<\/jats:p>","DOI":"10.3390\/jcm11030570","type":"journal-article","created":{"date-parts":[[2022,1,25]],"date-time":"2022-01-25T20:40:18Z","timestamp":1643143218000},"page":"570","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["The Combination of Lymph Node Transfer and Excisional Procedures in Bilateral Lower Extremity Lymphedema: Clinical Outcomes and Quality of Life Assessment with Long-Term Follow-Up"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9105-1839","authenticated-orcid":false,"given":"Luigi","family":"Losco","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, China Medical University, Taichung 404, Taiwan"},{"name":"Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6418-2873","authenticated-orcid":false,"given":"Alberto","family":"Bolletta","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, China Medical University, Taichung 404, Taiwan"},{"name":"Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5541-8346","authenticated-orcid":false,"given":"Alessandro","family":"de Sire","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro \u201cMagna Graecia\u201d, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shih-Heng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Chang Gung Memorial Hospital, Taoyuan City 33305, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8005-5049","authenticated-orcid":false,"given":"Gokhan","family":"Sert","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, China Medical University, Taichung 404, Taiwan"},{"name":"Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara 06010, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dicle","family":"Aksoyler","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, China Medical University, Taichung 404, Taiwan"},{"name":"Division of Plastic and Reconstructive Surgery Nicklaus Children\u2019s Hospital, Miami, FL 33155, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Velazquez-Mujica","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, China Medical University, Taichung 404, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5141-0681","authenticated-orcid":false,"given":"Marco","family":"Invernizzi","sequence":"additional","affiliation":[{"name":"Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy"},{"name":"Translational Medicine, Dipartimento Attivit\u00e0 Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuele","family":"Cigna","sequence":"additional","affiliation":[{"name":"Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hung-Chi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, China Medical University, Taichung 404, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1089\/lrb.2016.0049","article-title":"Does lymphedema severity affect quality of life? Simple question. Challenging answers","volume":"16","author":"Lee","year":"2018","journal-title":"Lymphat. Res. 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