Managing Severe Lymphoedema: Lymphovenous Anastomosis and Lymph Node Transfer

As with any surgery, there is a roughly 4-5% complication rate per case, managed through department protocols designed to minimise it. Patients prone to keloid scarring can develop keloid formation after cosmetic procedures. Patients with comorbidities like diabetes, hypertension or thyroid disease carry a higher chance of wound dehiscence, infection, haematoma or seroma formation, these are best thought of as expected side effects to plan around rather than true complications in most cases.

Yes, it varies significantly. For the arm, the golden period is 4 hours. For the forearm, 6 hours. For fingers, replantation can be attempted even at 8-10 hours. Early in his practice, proximal replantation was attempted at 10-12 hours, but the post-operative course was unpredictable enough that the lesson learned was not to attempt proximal replantation beyond 4, at most 6, hours.

Yes. For fingers, toe-to-hand transfer can restore good functional benefit even when the original finger wasn't salvaged in time. A few centres, though not this one yet, have started cadaveric hand transplant, though this is legally restricted in India to Indian citizens only, ruling it out for international patients. This centre is planning to start a hand transplant programme within about a year to a year and a half. In the meantime, options include toe transfer, cosmetic prostheses including osseointegrated ones, and myoelectric bionic hands.

Three things: clinical examination first, to map out the deformity pattern and plan; nerve conduction study and EMG, to identify how many donor nerves or muscles are available for transfer; and MRI, to map the brachial plexus itself. Both birth-related (obstetric) and adult traumatic or oncological brachial plexus injuries are managed with this same three-part workup.

For facial procedures, growth is considered complete by around 15-16 years, so a 15-year-old's face is functionally comparable to an adult's for surgical purposes, with parental consent sufficient at that age. For the rest of the body, 17-18 is considered the optimum age, since patients are mature enough by then to properly weigh their own body image and understand the implications of the procedure.

A microsurgical technique connecting functional lymphatic vessels, identified through lymphography, directly into small veins to restore lymphatic drainage and reduce limb swelling.

To prevent lymphoedema recurring after debulking surgery, by transferring healthy lymph nodes, along with their blood supply, from a donor site such as the neck to the affected limb.