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了解更多有關術後照顧的重點，患者不再需要穿戴壓力袖套、襪，但建議患者在術後接受3~6個月的復健，需要積極治療。 Post-Operative Care Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Post-Operative Rehabilitation The A+ Surgery Clinic provides comprehensive and extensive medical services before and after surgery. It is recommended that lymphedema patients receive post-operative rehabilitation for a period of 3- 6 months. It is most noteworthy that patients no longer need to wear compression garments after Dr. Cheng’s Side-to-End Lymphovenous anastomosis and vascularized submental lymph node flap transfer to distal recipient site for post-operative rehabilitation. It is recommended to massage from the proximal limb to the distal site for 15 minutes 3 times a day one month post-operatively for 3 to 6 months to further improve lymphatic drainage. Post-Operative Follow-Up The lymphedema of both upper and lower extremities can cause pain, discomfort, fibrosis, cosmetic problems, and mobility restraints for patients. It is common that lymphedema patients develop various degrees of depression due to physical discomfort, disfiguration, and emotional distress. With an average of a 2-year follow up after undergoing microsurgical microsurgery including Side-to-End Lymphovenous anastomosis and vascularized lymph node flap transfer to distal recipient site, the affected limb become softer overtime. 90% of lymphedema patients have seen size improvement with a mean circumferential difference of 50%. With the physical improvement, patients are subjectively pleased to resume daily activities and life styles they used to have. After vascularized submental lymph node flap transfer, you are asked to comply with the rehabilitation program, which includes progressive lower limb muscle strength training and reverse manual proximal (groin) to distal (ankle) lymphatic drainage. You are encouraged to gradually massage the flap, scar, and control body weight control starting after discharge. Reverse manual lymph drainage and flap massage are performed for 15 minutes/time, 3 times daily. You are advised to return to normal activity gradually as tolerated, and all other physiotherapy and compression wrapping are discontinued. Vascularized submental lymph node flap is placed on the wrist in accordance with the “pump” mechanism and effects of gravity. You do not need to wear a compression garment or bandaging after surgery but are allowed to wear a wrist brace or wrist support to hide the scar on the wrist after the wound complete healed. Another revision surgery to remove the skin paddle and superficial fat of the transferred flap to improve the cosmetic appearance and simultaneous liposuction of the thigh to decrease the production of lymph is recommended after 1 year of vascularized submental lymph node flap transfer. 1. Reverse manual lymph drainage: Time: Performed for 15 minutes/time, 3 times a day, from groin to flap. Method: Medium strength massage that compresses the skin, subcutaneous, fat and muscle in proximal (groin) to distal (flap) direction. This helps encourage drainage of the lymph drainage through the lymph flap and appropriate channels. 2. Flap massage: For increasing the venous drainage of lymph node flap pumping Time: Performed for 15 minutes/time, each 3 times daily. Method: Medium strength massage to pump lymph node flap and the scar around flap. 3. Body weight control: Time: Check body weight every day. Lighten your weight if your Body Mass Index(BMI) over 25. 4. Infection/cellulitis prevention and control: Most healthcare-associated infections are preventable through good hand hygiene. It’s important to identify and treat cellulitis early because the condition can spread rapidly throughout your body. Red area or “New red spots” of skin that tends to extend from distal to proximal Swelling Tenderness Pain Fever over 38.5℃ After the initial postoperative period, you are seen on a monthly basis by sending images. You may use any communication apps, such as Line, WhatsApp, Skype, e-mail or WhatsApp. Surgical outcomes are evaluated by your subjective improvement, circumferential measurements, the frequency of cellulitis, and via patient reported health-related quality of life outcome metrics. We will arrange ultrasonography, CT, and lymphoscintigraphy for checking the number of the lymph node on the flap, lymph node function and volume of the arm after one year.

瞭解更多有關淋巴水腫的成因，淋巴液和淋巴結的差別，淋巴系統的重要性，淋巴循環的流程圖，作為免疫系統的一部分，這些是你必須知道的事。 What is the Lymphatic System? As part of the immune system, the lymphatic system helps the body activate a specific immune response against viruses and bacteria. It retains fluid homeostasis in all different compartments of the body. It is made by channels called lymphatic vessels. These collect lymph from all over the body and deliver lymph to the regional lymph nodes or thoracic ducts and then back to the cardiovascular system. What Causes Lymphedema? Lymphedema occurs when your lymphatic system is unable to properly drain lymph fluid. In addition to primary (congenital) lymphedema, secondary lymphedema is more common and is usually caused by diseases or other treatments. Secondary lymphedema is a common complication after lymph node removal, typically occurring following cancer surgery and radiation therapy. Additionally, lymphedema can result from lymph node damage caused by infections. When the lymphatic system becomes blocked, lymph fluid cannot drain efficiently, leading to fluid buildup in the arms and legs. What is Lymph fluid? Lymph is a colorless protein-rich fluid that physiologically collects waste products and pathogens. It is present in tissue and transported through the lymphatic system to regional lymph-nodes. The venous flow carries 90% of arterial blood back to the heart and the remaining 10% becomes lymph fluid in the interstitial. Peripheral lymph nodes drain approximately 4-8 liters of lymph fluid per day. The lymphocytes (infection-fighting cells) that reside in the lymph nodes activate a specific immune response against infection. What are Lymph Nodes? Lymph nodes are bean-shaped organs of the lymphatic system that are distributed widely throughout the body. They are composed by lymphoid tissue enclosed by a capsule of connective tissue. Lymph nodes are major sites of B cells, T cells, and other immune cells. They serve as filters for the blood and provide specialized tissues where foreign antigens and cancer cells can be trapped and exposed to cells of the immune system for destruction. They are typically found concentrated near junctions of the major lymphatic vessels and most prominently found in the neck, groin, and armpits. Why is the lymphatic system important? The lymphatic system has two important roles: activating the immune response against antigens and transporting lymph fluid. Both functions are important to preserve body homeostasis. When the lymphatic system is compromised by cancer, infections, surgery, trauma, or congenital issues, the affected part of the body is prone to swelling (lymphedema) and recurrent infection due to the faulty surveillance mechanism. The functions of the lymphatic circulation include prevention and resolution of edema, maintenance of interstitial fluid homeostasis, immune trafficking (the regulated transit of antigen-presenting cells to the lymphoid organs), and lipid absorption from the gastrointestinal tract. Recipient Site of Vascularized Lymph Notes Transfer I.Wrist, dorsal or volar II. Elbow III. Axilla IV. Groin V. Posterior proximal leg VI. Ankle, anterior or medial Pathophysiology of Lymphedema i. Lymph accumulation ii. Inflamation iii. Infection iv. Fat proliferation v. Fibrosis Donor Vascularized Lymph Notes 1. Submental 2. Supraclavicular 3. Thoracic 4. Groin 5. Omentum 6. Mesenteric 此圖右側肢體正常，左側為上肢及下肢淋巴水腫。 可使用的治療方法如：淋巴管靜脈吻合術或顯微淋巴結皮瓣移植。 Lymphatic Circulation Flowchart Explanation of Physiological and Non-Physiological Surgical Approaches for Treating the Lymphatic System English 鄭教授淋巴水腫顯微外科手術學術里程碑

瞭解更多顯微淋巴結皮瓣移植的適合對象、手術結果、術前及術後的對比和分析，全部來自於鄭明輝教授的多年經驗。 Vascularized Lymph Node Flap Transfer (VLNT) Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery About VLNT Lymphedema can cause painful and unsightly swelling in the arms and/or legs. Though there are varying degrees of lymphedema, Dr. Cheng’s expert microsurgery techniques provide several possible solutions. For patients with Cheng’s Lymphedema late Grade II to Grade IV, and no clear functioning lymphatics shown on indocyanine green (ICG) lymphography images, a vascularized lymph node (VLN) flap transfer is recommended. For patients with more severe cases of lymphedema, such as lymphedema Grade IV, there may be a need for a liposuction or a partial wedge excision one year after the VLN flap transfer. Anderson, Your safe choice Medical Center Specifications and Equipment The operating room is equipped with Mitaka microscopes, of which there are only four in Taiwan. They have a resolution of up to 16 million pixels and can magnify 42 times optically. They are very suitable for the anastomosis of lymphatic vessels and veins of 0.5 mm and are often used in lymphatic venous anastomosis, such as preoperative evaluation and intraoperative evaluation of the permeability of sutures, making the operation more stable and safe. Candidates for VLN Flap Transfer Lymphedema patients who aggressively received rehabilitation for more than 6 months without making any improvement. Patients that develop episodes of cellulitis. Patients with total lymphatic obstruction present in diagnostic imaging (lymphoscintigraphy). Patients with no patent lymphatic (collecting) ducts available for the procedure of lymphovenous anastomosis (LVA). (See LVA section) Patitents with Cheng’s Grading Ⅱ, Ⅲ and Ⅳ lymphedema 淋巴結移植治療乳癌術後淋巴水腫 術前 術後 6 個月 術後 8 年 水腫2年 丹毒/蜂窩性組織炎2次 上臂改善：82％ 下臂改善：35％ 上臂改善：82％ 下臂改善：50％ 淋巴結移植治療乳癌術後淋巴水腫 術前 術後 3 個月 術後 8 年 水腫10年 丹毒/蜂窩性組織炎30次 體重60 kg 上臂改善：5 ％ 下臂改善：5 ％ 體重 59 kg ( 減少1kg ) 上臂改善：60 ％ 下臂改善：10 ％ 體重56 kg ( 減少4 kg ) 淋巴結移植治療二期乳癌術後淋巴水腫 術前 術後 24 個月 水腫2年 丹毒/蜂窩性組織炎3次 體重67kg 上臂改善：80 ％ 下臂改善：56 ％ 體重64 kg(減少3 kg) 淋巴結移植治療乳癌術後淋巴水腫 術前 術後 3 個月 術後 42 個月 水腫2年 丹毒/蜂窩性組織炎3次 上臂改善：25 ％ 下臂改善：15 ％ 上臂改善：90 ％ 下臂改善：90 ％ How Does It Work? The choice of the donor site for the VLN flap surgery is based on patient preference, and the availability of sizable lymph nodes at the preferred site. Before the donor site is chosen, Dr. Cheng uses ultrasound images to determine the viability of the lymph nodes. Given these factors, the vascularized submental lymph node (VSLN) flap is the most commonly preferred VLN flap by Dr. Cheng’s patients. Usually, the VSLN flap is transferred to the back of the wrist or to the ankle in accordance with the “pump” mechanism, catchment effect, and natural gravity effect to achieve maximal functional recovery. Though this surgery can provide great relief for painful swelling, the unsightly skin on the wrist may be bothersome to the patient. Fortunately, one-year after VSLN flap transfer surgery it can be removed, leaving a more subtle, linear scar. At this point, the limb previously affected by the lymphedema should be softer and smaller as well. Intrinsic lymphovenous connections exist within the lymph node flap. These connections are responsible for shunting the lymphatic fluid into the venous system, creating local decompression at the site of vascularized lymph node flap transfer. 資料來源： 淋巴水腫手術的原則和實踐。 Cheng MH，Chang DW，Patel KM（編輯）。 Elsevier Inc，英國牛津。 ISBN：978-0-323-29897-1。 2015年7月，第65頁。 此圖右側肢體正常，左側為上肢及下肢淋巴水腫。 可使用的治療方法如：淋巴管靜脈吻合術或顯微淋巴結皮瓣移植。 資料來源： 淋巴水腫手術的原則與實踐。 Cheng MH，Chang DW，Patel KM（編輯）。 Elsevier Inc，英國牛津。 ISBN：978-0-323-29897-1。 2015年7月，第219頁。 淋巴結供體區 1. 下領部 2. 鎖骨下 3. 胸椎 4. 腹股溝 5. 大網膜 6. 腸系膜 淋巴水腫的病理生理 a. 淋巴積聚 b. 炎症發炎 c. 脂肪增生 d.纖維化 淋巴結皮瓣接受區 I. 手腕（背部或手掌） II. 手肘 III. 腋下 IV. 腹股溝 V. 後腿近端 VI. 足踝（前側或内側） What to Expect After Flap Transfer Surgery Dr. Cheng’s unique surgical technique can greatly improve the quality of life of patients suffering from lymphedema. By transferring the vascularized lymph node flap to the recipient site, for example to the wrist, Dr. Cheng improves the functionality of the lymphatic system. As a result, the tissue becomes softer, the affected arms and/or legs become smaller and lighter and the patient experiences less cellulitis. This in turn gives the patient an improved cosmetic appearance. In addition, it is important to note that with Dr. Cheng’s superior technique and skills, patients no longer need to wear compression garments post-surgery. Although after VLN flap surgery the initial transferred flap on the wrist is not aesthetically pleasing, one year after the surgery the transferred skin may be removed. Typically done under local anesthesia, this procedure will leave the wrist with a subtle, linear scar instead. In Cheng’s experience, the success rate of the vascularized lymph node flap is 98%. With an average 18 months of follow-up after VLNT surgery, 90% of BCRL patients show substantial improvement, with an average circumferential difference improvement of 40%. Though patient results vary, in general, post-surgery the affected limb becomes much softer over time; and restriction of daily activities is minimized. After VLN flap surgery patients resume their normal life styles with a boost in self-confidence. A VLN Flap transfer with Dr. Cheng can alleviate lymphedema symptoms, greatly increasing patients’ quality of life. Evidences of Mechanism of Vascularized Lymph Node Transfer 1. Tc-99m Lymphoscintigraphy Increased Clearance on Static Images Static views of the same edematous upper limb on posterior view. Images of the upper extremity was taken at 30, 60 and 120 minutes after injection of radio-labelled tracer. Preoperative images (upper row: A-C) and postoperative images (lower row: D-F).In the pre-op images, there is prominent diffuse accumulation of activity shown in the skin of the affected forearm over time. Post-operatively, dermal backflow is less marked in the forearm (D-F) and the radio-labelled tracer has migrated more rapidly to the distal arm (arrow in F). Data source: Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Lin CH, Ali R, Chen SC, Wallace C, Chang YC, Chen HC, Cheng MH. Plast Reconstr Surg. 2009 Apr;123(4):1265-75. 2. Vascularized Groin Lymph Node Transfer to Elbow of Post-op Lymphoscintigraphy A 68-year-old female patient who was a victim of right upper limb lymphedema underwent vascularized groin lymph node flap transfer to right elbow (A). Preoperative lymphoscintigraphy showed accumulation of Tc-99 in the forearm and absence of right axilla lymph node (B). At a follow-up of 56 months, the patient was satisfied with the softening of left upper limb with a circumferential reduction of 58% above elbow and 40% below elbow (C). Post-op lymphoscintigraphy revealed increased uptake of Tc-99 by the transferred vascularized lymph nodes at the elbow level and less accumulation of Tc-99 in right upper arm (D). Data source: Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015, page 204-5. 3. Vascularized Submental Lymph Node Transfer to wrist of Post-op Lymphoscintigraphy A 52-year-old female patient who was a right upper limb lymphedema underwent vascularized submental lymph node flap transfer to right wrist. Pre-op lymphoscintigraphy showed accumulation of Tc-99 in the forearm and absence of right axilla lymph node. Post-op lymphoscintigraphy revealed increased uptake of Tc-99 by the transferred two vascularized lymph nodes at the wrist level and less accumulation of Tc-99 in right upper arm. Data source: Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015, page 204-5. 4. Intra-op Image Evidences of Mechanism of Vascularized Lymph Node Transfer ICG Injection on Lymph Node Directly Native Lymph Drainage through VSLN Flap Data source: Proposed pathway and mechanism of vascularized lymph node flaps. Ito R, Zelken J, Yang CY, Lin CY, Cheng MH. Gynecol Oncol. 2016 Apr;141(1):182-8. Q1 How can VLN surgery improve lymphedema? Lymphedema is caused by a blockage in the lymphatic system. If the lymph fluid is unable to circulate through the body, it builds-up and causes minor to severe swelling. Typically, lymphedema swelling is seen in the arms and/or the legs, though it can occur is other parts of the body. There are different degrees of lymphedema and some cases can be treated non-surgically. However, for certain types, such as Cheng's Grade II, III and IV lymphedema, surgery may be the only option to alleviate symptoms and reduce swelling. The VLN flap transfer unblocks the lymphatic system in order to allow the lymph fluid to circulate better, reducing swelling in the affected limb over time. Dr. Cheng has been extremely successful in using this technique to treat moderate to severe cases of lymphedema. Q2 Are follow-up appointments post-surgery required? VLN flap surgery with renowned surgeon Dr. Cheng has an excellent success rate. However, the VLN flap surgery is a delicate procedure that requires several follow up appointments after the surgery. These appointments allow Dr. Cheng to carefully measure the circumference of the affected limb or limbs to ensure optimal results. Dr. Cheng will discuss symptom relief with patients, which helps to determine the success of the transferred lymph nodes. Although no compression garments are needed, it is important to attend all follow-up appointments in order to assess progress anddetermine if any addition physical therapy is necessary. Q3 Why choose Dr. Cheng for VLN flap surgery? As an internationally renowned surgeon, Dr. Cheng is an expert in several microsurgery techniques that address lymphedema, including VLN flap surgery. With over a 98% success rate, Dr. Cheng can properly asses your condition and determine what is the best treatment plan. Depending on the grade of lymphedema, Dr. Cheng will recommend the best solution. As a plastic surgeon that specializes in reconstructive microsurgery, Dr. Cheng holds the world record for successfully treating the largest number of lymphedema patients with vascularized lymph node transfers. His unique technique and expert skill enable him to not only diagnose the cause and grade of lymphedema but also propose the best treatment to reduce patients' symptoms and improve their quality of life. Contact Dr. Cheng For A Consultation If you have Breast Cancer Related Lymphedema and would like to know more about the most advanced treatments, contact Dr. Cheng. Internationally recognized as a leading lymphedema specialist, Dr. Cheng can discuss treatment options, based on your individual case. Dr. Cheng is a member of the American Society of Reconstructive Microsurgery and has performed numerous VLN surgeries on breast cancer survivors and other lymphedema patients. Learn more

Visiting Professorships Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Godina Traveling Professor, Aesthetic & Plastic Surgery Institute University of California, Irvine, Orange, California, June 10, 2006. 2006 Godina Traveling Fellow and Flap Course Faculty, Duke University. Visiting Professor, Duke University Medical Center, Durham, Nort Carolina, August 4, 2006. Visiting Lecturer, M.D. Anderson Cancer Center Department of Plastic Surgery, Houston, Texas, November 13-15, 2006. Visiting Professor in Plastic Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, November 16-19, 2006. Visiting Professor in Plastic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, November 20-22, 2006. Visiting Professor in Institute of Reconstructive Plastic Surgery, New York University Lang one Medical Center, New York, October 25-29, 2008. Visiting Professor in Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota, October 29-31, 2008. Visiting Professor in Department of Plastic Surgery, The University of Texas MD Anderson Cancer, Houston, Texas, July 13-14, 2009 Visiting Professor in Division of Plastic Surgery, University of South California, Los Angeles, California, July 16-17, 2009. Visiting Professor in Division of Plastic Surgery, Mayo Clinic Phoenix, Arizona, October 27-29, 2009. Visiting Professor in Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, July 17-21,2010. Visiting Professor in Division of Plastic Surgery, Singapore General Hospital, Singapore, Singapore, July 13-17, 2011. Visiting Professor in Division of Plastic Surgery, the Ohio State University, July 10-14, 2012. Visiting Professor in Department of Plastic Surgery, MedStar Georgetown University Hospital, February 5, 2014. Visiting Professor in Department of Plastic Surgery, Brussels University Hospital, March 2-4, 2014. Visiting Professor in Department of Plastic Surgery, NYU Langone Medical Center, October 7-8, 2014. Visiting Professor in Department of Plastic Surgery, Asan Medical Center, University of Ulsan, March 26, 2015. Visiting Professor in Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University, March 27, 2015. Visiting Professor in Department of Plastic Surgery, University of Michigan, September 22-25, 2015. Visiting Professor in Department of Plastic Surgery, the Keck School of Medicine of the University of Southern California, January 14 - 15. 2016 Visiting Professor in Department of Plastic Surgery, Duke University Medical Center, Durham, North Carolina, February 22, 2016. ASRM William A. Zamboni Visiting Professor in Department of Plastic Surgery, University of California, San Diego, May 16-17, 2016. ASRM William A. Zamboni Visiting Professor in Department of Plastic Surgery, The University of Chicago Medicine & Biological Sciences,Chicago, September 18-19, 2016. ASRM William A. Zamboni Visiting Professor in Department of Plastic Surgery, University of California, Irvine, November 7-8, 2016. Visiting Professor in Department of Plastic Surgery, Memorial Sloan Kettering Cancer Center, New York, August 21, 2017. Visiting Professor in Department of Plastic Surgery, University of Michigan, Detroit, August 28 to 30, 2017. Visiting Professor in Department of Plastic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, November 3 to 4,2017. International Visiting Professor in Plastics Division, Stanford University, February 16-21, 2018. Visiting Professor in Department of Plastic Surgery, University of Michigan, Detroit, July 29 to August 1, 2018. Visiting Professor in the Department of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, August 8 to 10, 2019. Buncke Clinic Virtual Visiting Professor, Webinar, May 9, 2020. Visiting Professor in the Department of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, May 2 to 6, 2022.

Patient Rights Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery General Consent form A+ Surgery Clinic Patient’s rights and cooperation The cooperation between the patient and the medical team is an important factor for a successful treatment. The patient’s understanding towards patient’s rights and obligations is necessary for a mutual communication in order to promote cooperation and trust. During the patient’s visit to our hospital, we ensure that the following 10 patient’s rights are maintained. Please feel free to provide us with feedback if our services do not meet your expectations, in order for us to improve. It is necessary for the patient and family to provide us with relevant disease information so we can provide you with accurate diagnosis and the most suitable treatment while maximizing the use of limited medical resources to protect our medical environment and the health of everyone. We look forward to building a healthy and harmonious medical environment for all of our patients. Please feel free to approach any of our medical personnel if you have any further inquiries or suggestions about patient’s rights, and it will be our pleasure to assist you in every possible way. Patient’s Rights 【Treatment equality】The patient is entitled to receive treatment regardless of race, religion, nationality, gender, age, disease, sexual preference, location, or social status. 【Healthcare safety】The patient has the right to receive healthcare in a safe medical environment. 【Information and explanation】The patient and primary care provider are entitled to inquire about physician’s or other medical personnel’s names and disease information. 【Informed consent】【Right to refuse】【Alternatives】The patient and the primary family caregiver have the right to participate in the discussion and inquiry of the healthcare process and to decide in the treatment plan, including the rights to refuse treatment and to seek a second opinion. 【Continuous healthcare】The patient has the right to request for pain management, disease management, medication, diet and daily living education, and information and medical services relative to home care services after discharge. 【Palliative Care】According to the hospice and palliative laws and regulations, the patient and the family have the right to decide or alter the decision of “do not resuscitate,” and to renounce the use of life support during cardiac arrest at the risk of termination of life. 【Patient’s privacy】We respect and uphold the patient’s privacy. Disease information and records will be kept confidential. 【Information providing】According to the law, the patient has the right to request for copies of his/her medical record, certificate of diagnosis, and invoice of medical expenses. 【Complain Service】The patient has the right to complain or make suggestions to the hospital, and we will respond accordingly. 【Professional Service】All medical personnel must wear identification cards. The patient can refuse to accept medical service if the medical personnel does not wear an identification card. Patient cooperation To ensure patient safety, the patient and family should provide information such as health condition, medical history, drug history, allergy history, travelling history, contagious disease at present, etc. The patient and family should participate in the discussion of treatment plans and come to a conclusion after understanding the consequences of all possible treatments. All doubts should be clarified with the medical personnel in charge prior to the signing of the consent form. The patient and family should cooperate with physicians in terms of treatment, discharge, or transferal. Please respect our medical resources and the medical facilities of the hospital. Please comply to the hospital’s policies and operating procedures. Never request medical personnel to provide false information or certificate of diagnosis. Please obey the hospital’s curfew and infection policy. Please do not smoke or chew betel nuts in the hospital to prevent affecting the rights of other patients. Please pay the remaining balance after subsidy accordingly. Please approach our social workers or medical personnel in charge if you have any difficulty paying the balance. We provide storage services for the patient and family to secure their personal belongings. We are not responsible for damage or loss of property. Please keep your valuables with you at all times.

瞭解更多安德森整形外科三位專業醫師的門診時間：鄭明輝 院長、杜隆成主任醫師及張豫苓主任醫師，週一至週五皆有門診。 Outpatient clinic hours Tuesday, Thursday and Friday. 1:30 - 4:00 p.m.

鄭明輝教授發表66篇淋巴水腫論文和兩本教科書篇章，與國際學術醫界連結，為顯微重建整型外科及淋巴水腫世界權威 Publications Dr. Cheng's Publications in Lymphedema Microsurgery Dr. Cheng's Book and Chapter 1. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Lin CH, Ali R, Chen SC, Wallace C, Chang YC, Chen HC, Cheng MH. Plast Reconstr Surg. 2009 Apr;123(4):1265-75. doi: 10.1097/PRS.0b013e31819e6529. https://www.ncbi.nlm.nih.gov/pubmed/19337095 2. A novel approach to the treatment of lower extremity lymphedema by transferring a vascularized submental lymph node flap to the ankle. Cheng MH, Huang JJ, Nguyen DH, Saint-Cyr M, Zenn MR, Tan BK, Lee CL. Gynecol Oncol. 2012 Jul;126(1):93-8. doi: 10.1016/j.ygyno.2012.04.017. Epub 2012 Apr 17. https://www.ncbi.nlm.nih.gov/pubmed/22516659 3. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes.. Cheng MH, Chen SC, Henry SL, Tan BK, Lin MC, Huang JJ. Plast Reconstr Surg. 2013 Jun;131(6):1286-98. doi:10.1097/PRS.0b013e31828bd3b3 https://www.ncbi.nlm.nih.gov/pubmed/23714790 4. Preplanning Vascularized Lymph Node Transfer with Duplex Ultrasonography: An Evaluation of 3 Donor Sites. Patel KM, Chu SY, Huang JJ, Wu CW, Lin CY, Cheng MH. Plast Reconstr Surg Glob Open. 2014 Sep 8;2(8):e193. doi: 10.1097/GOX.0000000000000105. eCollection 2014 Aug. https://www.ncbi.nlm.nih.gov/pubmed/25426376 5. The use of magnetic resonance angiography in vascularized groin lymph node transfer: an anatomic study. Dayan JH, Dayan E, Kagen A, Cheng MH, Sultan M, Samson W, Smith ML. J Reconstr Microsurg. 2014 Jan;30(1):41-5. doi: 10.1055/s-0033-1351668. Epub 2013 Sep 9. https://www.ncbi.nlm.nih.gov/pubmed/24019175 6. The mechanism of vascularized lymph node transfer for lymphedema: natural lymphaticovenous drainage. Cheng MH, Huang JJ, Wu CW, Yang CY, Lin CY, Henry SL, Kolios L. Plast Reconstr Surg. 2014 Feb;133(2):192e-8e. doi: 10.1097/01.prs.0000437257.78327.5b. https://www.ncbi.nlm.nih.gov/pubmed/24469190 7. Developing a Lower Limb Lymphedema Animal Model with Combined Lymphadenectomy and Low-dose Radiation. Yang CY, Nguyen DH, Wu CW, Fang YH, Chao KT, Patel KM, Cheng MH. Plast Reconstr Surg Glob Open. 2014 Apr 7;2(3):e121. doi: 10.1097/GOX.0000000000000064.eCollection 2014 Mar. https://www.ncbi.nlm.nih.gov/pubmed/25289315 8. Vascularized lymph node flap transfer and lymphovenous anastomosis for klippel-trenaunay syndrome with congenital lymphedema. Qiu SS, Chen HY, Cheng MH. Plast Reconstr Surg Glob Open. 2014 Jul 9;2(6):e167. doi: 10.1097/GOX.0000000000000099. eCollection 2014 Jun. https://www.ncbi.nlm.nih.gov/pubmed/25289360 9. From theory to evidence: long-term evaluation of the mechanism of action and flap integration of distal vascularized lymph node transfers. Patel KM, Lin CY, Cheng MH. J Reconstr Microsurg. 2015 Jan;31(1):26-30. doi: 10.1055/s-0034-1381957. Epub 2014 Aug 19. https://www.ncbi.nlm.nih.gov/pubmed/25137504 10. Quantity of lymph nodes correlates with improvement in lymphatic drainage in treatment of hind limb lymphedema with lymph node flap transfer in rats. Nguyen DH, Chou PY, Hsieh YH, Momeni A, Fang YH, Patel KM, Yang CY, Cheng MH. Microsurgery. 2016 Mar;36(3):239-45. doi: 10.1002/micr.22388. Epub 2015 Feb 25. https://www.ncbi.nlm.nih.gov/pubmed/25715830 11. Simultaneous Bilateral Submental Lymph Node Flaps for Lower Limb Lymphedema Post Leg Charles Procedure. Ito R, Lin MC, Cheng MH. Plast Reconstr Surg Glob Open. 2015 Sep 15;3(9):e513. doi: 10.1097/GOX.0000000000000489. eCollection 2015 Sep. https://www.ncbi.nlm.nih.gov/pubmed/26495226 12. Successful treatment of early-stage lower extremity lymphedema with side-to-end lymphovenous anastomosis with indocyanine green lymphography assisted. Ito R, Wu CT, Lin MC, Cheng MH. Microsurgery. 2016 May;36(4):310-5. doi: 10.1002/micr.30010. Epub 2015 Dec 15. https://www.ncbi.nlm.nih.gov/pubmed/26666982 13. Lymphedema surgery: Patient selection and an overview of surgical techniques. Allen RJ Jr, Cheng MH. J Surg Oncol. 2016 Jun;113(8):923-31. doi: 10.1002/jso.24170. Epub 2016 Feb 5. Review. https://www.ncbi.nlm.nih.gov/pubmed/26846615 14. Surgical anatomy of the vascularized submental lymph node flap: Anatomic study of correlation of submental artery perforators and quantity of submental lymph node. Tzou CH, Meng S, Ines T, Reissig L, Pichler U, Steinbacher J, Pona I, Roka-Palkovits J, Rath T, Weninger WJ, Cheng MH. J Surg Oncol. 2017 Jan;115(1):54-59. doi: 10.1002/jso.24336. Epub 2016 Jun 23. https://www.ncbi.nlm.nih.gov/pubmed/27338566 15. The 5th world symposium for lymphedema surgery-Recent updates in lymphedema surgery and setting up of a global knowledge exchange platform. Loh CY, Wu JC, Nguyen A, Dayan J, Smith M, Masia J, Chang D, Koshima I, Cheng MH. J Surg Oncol. 2017 Jan;115(1):6-12. doi: 10.1002/jso.24341. Epub 2016 Jun 28. Review. https://www.ncbi.nlm.nih.gov/pubmed/27353481 16. The surgical anatomy of the supraclavicular lymph node flap: A basis for the free vascularized lymph node transfer. Steinbacher J, Tinhofer IE, Meng S, Reissig LF, Placheta E, Roka-Palkovits J, Rath T, Cheng MH, Weninger WJ, Tzou CH. J Surg Oncol. 2017 Jan;115(1):60-62. doi: 10.1002/jso.24346. Epub 2016 Jun 28. https://www.ncbi.nlm.nih.gov/pubmed/27353521 17. The 5th World Symposium for Lymphedema Surgery. Cheng MH, Koshima I, Chang DW, Masia J. J Surg Oncol. 2017 Jan;115(1):5. doi: 10.1002/jso.24383. Epub 2016 Jul 29. No abstract available. https://www.ncbi.nlm.nih.gov/pubmed/27473624 18. Platysma-sparing vascularized submental lymph node flap transfer for extremity lymphedema. Poccia I, Lin CY, Cheng MH. J Surg Oncol. 2017 Jan;115(1):48-53. doi: 10.1002/jso.24350. Epub 2017 Jan 6. https://www.ncbi.nlm.nih.gov/pubmed/28058777 19. A prospective clinical assessment of anatomic variability of the submental vascularized lymph node flap. Cheng MH, Lin CY, Patel KM. J Surg Oncol. 2017 Jan;115(1):43-47. doi: 10.1002/jso.24487. Epub 2017 Jan 13. https://www.ncbi.nlm.nih.gov/pubmed/28083889 20. Greater Omental Lymph Node Flap for Upper Limb Lymphedema with Lymph Nodes-depleted Patient. Chu YY, Allen RJ Jr, Wu TJ, Cheng MH. Plast Reconstr Surg Glob Open. 2017 Apr 25;5(4):e1288. doi: 10.1097/GOX.0000000000001288. eCollection 2017 Apr. https://www.ncbi.nlm.nih.gov/pubmed/28507857 21. The surgical anatomy of the vascularized lateral thoracic artery lymph node flap-A cadaver study. Tinhofer IE, Meng S, Steinbacher J, Roka-Palkovits J, Györi E, Reissig LF, Cheng MH, Weninger WJ, Tzou CH. J Surg Oncol. 2017 Dec;116(8):1062-1068. doi: 10.1002/jso.24783. Epub 2017 Aug 7. 22. Visualization of Skin Perfusion by Indocyanine Green Fluorescence Angiography-A Feasibility Study. Steinbacher J, Yoshimatsu H, Meng S, Hamscha UM, Chan CS, Weninger WJ, Wu CT, Cheng MH, Tzou CH. Plast Reconstr Surg Glob Open. 2017 Sep 25;5(9):e1455. doi: 10.1097/GOX.0000000000001455. eCollection 2017 Sep. https://www.ncbi.nlm.nih.gov/pubmed/29062637 23. Vascularized lymph node transfer for treatment of extremity lymphedema: An overview of current controversies regarding donor sites, recipient sites and outcomes. Pappalardo M, Patel K, Cheng MH. J Surg Oncol. 2018 Jun;117(7):1420-1431. doi: 10.1002/jso.25034. Epub 2018 Mar 24. Review. https://www.ncbi.nlm.nih.gov/pubmed/29572824 24. Vascularized Lymph Node Transfer for Lymphedema. Schaverien MV, Badash I, Patel KM, Selber JC, Cheng MH. Semin Plast Surg. 2018 Feb;32(1):28-35. doi: 10.1055/s-0038-1632401. Epub 2018 Apr 9.Review. https://www.ncbi.nlm.nih.gov/pubmed/29636651 25. Accurate Prediction of Submental Lymph Nodes Using Magnetic Resonance Imaging for Lymphedema Surgery. Asuncion MO, Chu SY, Huang YL, Lin CY, Cheng MH. Plast Reconstr Surg Glob Open. 2018 Mar 23;6(3):e1691. doi: 10.1097/GOX.0000000000001691. eCollection 2018 Mar. https://www.ncbi.nlm.nih.gov/pubmed/29707451 26. Critical Ischemia Time, Perfusion and Drainage Function of Vascularized Lymph Nodes. Yang CY, HO OA, Cheng MH, Hsiao HY. Plast Reconstr Surg. 2018 Jun 12. doi: 10.1097/PRS.0000000000004673. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/29927833 27. Correlation between Quantity of Transferred Lymph Nodes and Outcome in Vascularized Submental Lymph Node Flap Transfer for Lower Limb Lymphedema. Gustafsson J, Chu SY, Chan WH, Cheng MH. Plast Reconstr Surg. 2018 Jul 10. doi: 10.1097/PRS.0000000000004793. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/30020232 28. Acoustic Radiation Force Impulse Elastography: Tissue Stiffness Measurement in Limb Lymphedema. Chan WH, Huang YL, Lin C, Lin CY, Cheng MH, Chu SY. Radiology. 2018 Aug 14:172869. doi: 10.1148/radiol.2018172869. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/30106341 29. Lymph node transplantation for the treatment of lymphedema. Gould DJ, Mehrara BJ, Neligan P, Cheng MH, Patel KM. J Surg Oncol. 2018 Aug 21. doi: 10.1002/jso.25180. [Epub ahead of print] Review. https://www.ncbi.nlm.nih.gov/pubmed/30129675 30. Effectiveness of Vascularized Lymph Node Transfer for Extremity Lymphedema Using Volumetric and Circumferential Differences Gustafsson J, Chu SY, Chan WH, Cheng MH. Plast Reconstr Surg. 2018 Jul 10. doi: 10.1097/PRS.0000000000004793. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/30020232 31. Lymphedema and concomitant venous comorbidity in the extremity: Comprehensive evaluation, management strategy, and outcomes. Sachanandani N S, Chu SY, Ho O A., Cheong CF, Lin CY, Cheng MH*. J Surg Oncol. 2018 Nov;118(6):941-952. doi: 10.1002/jso.25237. https://www.ncbi.nlm.nih.gov/pubmed/ ? term=Lymphedema+and+concomitant+venous+comorbidity+in+the+extremity%3A+Comprehensive+evaluation%2C+management+strategy%2C+and+outcomes 32. Outcomes of Vascularized Lymph Node Transfer and Lymphovenous Anastomosis for Treatmentof Primary Lymphedema. Cheng MH, Loh CYY, Lin CY. Plats Reconstr Surg Glob Open. 2018 Dec 20;6(12):e2056. https://journals.lww.com/prsgo/Fulltext/2018/12000/Outcomes_of_Vascularized_Lymph Node_Transfer_and.15.aspx 33. Comparisons of Submental and Groin Vascularized Lymph Node Flaps Transfer for BreastCancer-Related Lymphedema. Ho OA, Lin CY, Pappalardo M, Cheng MH. Plats Reconstr Surg Glob Open. 2018 Dec 13;6(12):e1923. https://journals.lww.com/prsgo/Fulltext/2018/12000/Comparisons_of_Submental_and_Groin_Vascularized.13.aspx 34. A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. Sachanandani N S, Chu SY, Ho O A., Cheong CF, Lin CY, Cheng MH*. J Surg Oncol. 2018 Nov;118(6):941-952. doi: 10.1002/jso.25237. https://www.ncbi.nlm.nih.gov/pubmed/ ? term=Lymphedema+and+concomitant+venous+comorbidity+in+the+extremity%3A+Comprehensive+evaluation%2C+management+strategy%2C+and+outcomes 35. Proposed pathway and mechanism of vascularized lymph node flaps. Ito R, Zelken J, Yang CY, Lin CY, Cheng MH. Gynecol Oncol. 2016 Apr;141(1):182-8. doi: 10.1016/j.ygyno.2016.01.007. Epub 2016 Jan 7. https://www.ncbi.nlm.nih.gov/pubmed/26773469 36. Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction. Ho OA, Lin CY, Pappalardo M, Cheng MH. Ann Surg. 2017 Jun 7. doi: 10.1097/SLA.0000000000002322. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/28594742 37. Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema. Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC. Ann Surg. 2018 Sep;268(3):513-525. doi: 10.1097/SLA.0000000000002917. https://www.ncbi.nlm.nih.gov/pubmed/30004927 38. Dorsal Wrist Placement for Vascularized Submental Lymph Node Transfer Significantly Improves Breast Cancer-Related Lymphedema. Hattan A, Fries Charles Anton, BChir, FRCS, Cheng Ming-Huei. Plastic and Reconstructive Surgery - Global Open: 2019 Feb, 7(2): e2149. https://journals.lww.com/prsgo/Fulltext/2019/02000/Dorsal_Wrist Placement_for_Vascularized_Submental.14.aspx 39. Comparison of Outcomes between Side-to-End and End-to-End Lymphovenous Anastomoses for Early-Grade Extremity Lymphedema. Fahad K. Al-Jindan, Lin CY, Cheng MH. Plast Reconstr Surg. 2019 May 10. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31188305 40. Factors associated with professional healthcare advice seeking in breast cancer-related lymphedema. Lin CY, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):67-74. doi: 10.1002/jso.25523. Epub 2019 Jun 18. https://www.ncbi.nlm.nih.gov/pubmed/31209885 41. Lymphoscintigraphy for the Diagnosis of Extremity Lymphedema: Current Controversies Regarding Protocol, Interpretation and Clinical Application. Pappalardo M, Cheng MH. J Surg Oncol. 2020 Jan;121(1):37-47. doi: 10.1002/jso.25526. Epub 2019 Jun 18. https://www.ncbi.nlm.nih.gov/pubmed/31209893 42. Intra-abdominal Chylovenous Bypass Treats Retroperitoneal Lymphangiomatosis. Chen C, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):75-84. doi: 10.1002/jso.25514. Epub 2019 Jul 4. https://www.ncbi.nlm.nih.gov/pubmed/31273800 43. Lymphedema Microsurgery Reduces the Rate of Implant Removal for Patients Who Have Pre-existing Lymphedema and Total Knee Arthroplasty for Knee Osteoarthritis. Voravitvet TY, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):57-66. doi: 10.1002/jso.25517. Epub 2019 Jun 13. https://www.ncbi.nlm.nih.gov/pubmed/31197837 44. Clinical Features, Microbiological Epidemiology and Recommendations of Management for Cellulitis in Extremity Lymphedema. Rodriguez JR, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):25-36. doi: 10.1002/jso.25525. Epub 2019 Jul 2. https://www.ncbi.nlm.nih.gov/pubmed/31264724 45. Delayed Primary Retention Suture: A new technique to inset Vascularized Submental Lymph Node Transfer. Koide S, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):138-143. doi: 10.1002/jso.25520. Epub 2019 Jul 5. https://www.ncbi.nlm.nih.gov/pubmed/31276208 46. Long-Term Outcome of Lower Extremity Lymphedema Treated with Vascularized Lymph Node Flaps with Venous Complications. Koide S, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):129-137. doi: 10.1002/jso.25602. Epub 2019 Jun 27. https://www.ncbi.nlm.nih.gov/pubmed/31246288 47. Summary of hands-on supermicrosurgery course and live surgeries at 8th world symposium for lymphedema surgery. Pappalardo M, Cheng MH et al. J Surg Oncol. 2020 Jan;121(1):8-19. doi: 10.1002/jso.25619. Epub 2019 Jul 16. https://www.ncbi.nlm.nih.gov/pubmed/31309553 48. Introduction of the 8th World Symposium for Lymphedema Surgery. Cheng MH, Chang DW, Masia J, Koshima I. J Surg Oncol. 2020 Jan;121(1):7. doi: 10.1002/jso.25620. Epub 2019 Jul 9. https://www.ncbi.nlm.nih.gov/pubmed/31290156 49. Impacts of Arterial Ischemia or Venous Occ.usion on Vascularized Groin Lymph Nodes in a Rat Model. Tinhofer I. E., Yang CY, Chen C, Cheng MH. J Surg Oncol. 2020 Jan;121(1):153-162. doi: 10.1002/jso.25518. Epub 2019 May 31. https://www.ncbi.nlm.nih.gov/pubmed/31152457 50. Volumetric Differences in the Superficial and Deep Compartments of Patients with Secondary Unilateral Lower Limb Lymphedema. Chu SY, Cheng MH et al. Plast Reconstr Surg. (paper in press) 51. Efficacy validation of a lymphatic drainage device for lymphedema drainage in a rat model. Cheng MH, Yang CY, Tee R, Hong YT, Lu CC. J Surg Oncol. 2019 Dec;120(7):1162-1168. https://www.ncbi.nlm.nih.gov/pubmed/?term=Efficacy+validation+of+a+lymphatic+drainage+device+for+lymphedema+drainage+in+a+rat+model 52. Institutionalization of Reconstructive Lymphedema Surgery in Austria - Single Center Experience. Tzou CHJ, Cheng MH et al. J Surg Oncol. 2020 Jan; 121(1):91-99. https://www.ncbi.nlm.nih.gov/pubmed/?term=Institutionalization+of+Reconstructive+Lymphedema+Surgery+in+Austria+%E2%80%93+Single+Center+Experience 53. Comparisons of Manual Tape Measurement and Morphomics Measurement of Patients with Upper Extremity Lymphedema. Horbal SR, Chu SY, Cheng MH* et al. Plast Reconstr Surg Global Open. 2019 Oct 29;7(10): e2431 https://www.ncbi.nlm.nih.gov/pubmed/ ? 54. Characterization of limb lymphedema using the statistical analysis of ultrasound backscattering. Lee YL, Cheng MH et al. Quant Imaging Med Surg. 2020;10(1):48-56. 55. Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Different-Severities Extremity Lymphedema. Cheng MH*, Tee R, Chen C, Lin CY, Pappalardo M. Ann Surg Oncol. 2020 Jun 18. doi: 10.1245 56. ASO Author Reflection: Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Different-Severities Extremity Lymphedema. Horbal SR, Chu SY, Cheng MH* et al. Ann Surg Oncol. 2020 Jul 10. 57. Lymphedema microsurgery improved outcomes of pediatric primary extremity lymphedema. Cheng MH*, Liu TTF. Microsurgery, 2020 Jul 11. 58. Chylovenous bypass for mesenteric lymphangiomatosis: A case report. Chen C,Cheng MH*. J Surg Oncol. 2020 Jul 15. 59. Staging and clinical correlations of lymphoscintigraphy for unilateral gynecological cancerrelated lymphedema. Pappalardo M, Lin C, Ho OA, Kuo CF, Lin CY, Cheng MH". J Surg Oncol. 2020 Mar;121(3):422-434. 60. Morbidity of Marginal Mandibular Nerve Post Vascularized Submental Lymph Node Flap Transplantation. Chang Tommy NJ, Lee CH, Lin Jennifer AJ, Cheng MH*. J Surg Oncol. 2020 Dec;122(8):1747-1754 https://pubmed.ncbi.nlm.nih.gov/32869304/ 61. Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Different-Severities Extremity Lymphedema. Cheng MH*, Tee R, Chen C, Lin CY, Pappalardo M. Ann Surg Oncol. 2020 Jun 18. https://pubmed.ncbi.nlm.nih.gov/32556869/ 62. ASO Author Reflections: Simultaneous Ipsilateral Vascularized Lymph Node Transplantation and Contralateral Lymphovenous Anastomosis in Bilateral Different-Severities Extremity Lymphedema. Cheng MH*. Ann Surg Oncol. 2020 Dec;27(13):5277-5278. https://pubmed.ncbi.nlm.nih.gov/32651692/ 63. Response to letter to the editor: Evidence of Lymph Flow Amelioration on Indocyanine Green Lymphography after Vascularized Lymph Node Transfer. Cheng MH". Ann Surg Oncol. 2021 Jun;123(7):1641. https://pubmed.ncbi.nlm.nih.gov/33825195/ 64. Retrograde Manual Lymphatic Drainage following Vascularized Lymph Node Transfer to Distal Recipient Sites for Extremity Lymphedema: A Retrospective Study and Literature Review. Roka-Palkovits J, Lin CY, Tzou CH J, Tinhofer, Cheng MH*. Plast Reconstr Surg. 2021 Sep 1;148(3):425e-436e. https://pubmed.ncbi.nlm.nih.gov/34432699/ 65. Immediate Lymphovenous Bypass Treated Donor Site Lymphedema during Phalloplasty for Gender Dysphoria. Lin W, Safa B, Chen M, Cheng MH*. Plast Reconstr Surg Glob Open. 2021 Sep 17;9(9):e3822. https://pubmed.ncbi.nlm.nih.gov/34549009/ 66. Heparin-induced thrombocytopenia and thrombosis in primary lymphedema patients who underwent vascularized lymph node transplantations. Hsu SY, Lin CY, Cheng MH*. J Surg Oncol. 2022 Feb 2. https://pubmed.ncbi.nlm.nih.gov/35107827 Book: Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. ISBN: 978-0-323-29897-1. July 2015. Principles and Practice of Lymphedema Surgery 2nd Edition - January 7, 2021 Ming-Huei Cheng, David Chang, Ketan Patel. Paperback ISBN: 9780323694186 Book chapters: 16 1. Cheng MH, Nguyen DH, Huang JJ. Chapter 77: Vascularized Groin Lymph Node Flap for Treatment of Lymphedema. In: Perforator Flaps: Anatomy, Technique, & Clinical Applications. 2nd Edition. Blondeel PN, Morris SF, Hallock GG, and Neligan PC (Editors). Quality Medical Publishing, Inc. St. Louis, Missouri. 2013:1317-1328. 2. Cheng MH, Nguyen DH. Chapter 54: Lymph Node Transfer for Lymphedema. In: Operative Microsurgery. Boyd JB and Jones NF (Editors). McGraw-Hill, New York. 2015:672-682. 3. Tobbia D, Cheng MH. Vascularized Groin Lymph Node Flap Transfer for Post mastectomy Upper Limb Lymphedema. In Grabb's Encyclopedia of Flaps, 4th edition. Strauch B, Vasconez LO, Lee BT, and Herman CK (Editors). Wolters Kluwer, Philadelphia, PA, USA. 2015. 4. Tzou CHJ, Cheng MH. Transfer of lymph node tissue - my approach. In Oncoplastic and Reconstructive Management of the Breast: A Multidisciplinary Approach. CRC Press, Boca Raton, FL, 2015. 5. Cheng MH, Chang DW, Patel KM. Chapter 1: An introduction to principles and practice of lymphedema surgery. In Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. 2015 6. Nguyen DH, Cheng MH. Chapter 5: Laboratory study of lymphoma. In Principles and Practice of Lymphedema Surgery. Cheng MH, Chang DW, Patel KM (Editors). Elsevier Inc, Oxford, United Kingdom. 2015

Patient Testimonials Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Patient Testimonials Patient Testimonials Play Video Share Whole Channel This Video Facebook Twitter Pinterest Tumblr Copy Link Link Copied Search video... Now Playing Lymphedema Treatment Testimony: Canadian Patient at A+ Surgery Clinic, Taipei, Taiwan"Video Content: 09:51 Play Video Now Playing Lymphedema Treatment Testimony:In addition to excellent medical care, also enjoys Taiwanese cuisine 04:27 Play Video Now Playing Mr. William from Australia 05:50 Play Video

瞭解更多手臂淋巴水腫的成因及症狀，以及為何安德森整形外科是您的安心選擇，有任何問題歡迎電話及線上諮詢。 Upper Extremity Lymphedema Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery What Is Upper Extremity Lymphedema? Breast cancer patients who underwent axillary lymph node dissection following radiotherapy are at a higher risk of developing extremity lymphedema – Breast Cancer-Related Lymphedema (BCRL), a condition that results in tissue swelling and liquid retention in the arms. While it is possible to manage the condition with some home care, surgery may be necessary to significantly improve an individual’s comfort and quality of life. Ming-Heui Cheng, MD, FACS, a pioneer in plastic microsurgery and internationally renowned lymphedema specialist, performs vascularized lymph node flap transfers on lymphedema patients whose symptoms have not improved or continue to worsen six months after they emerged. Symptoms Of Lymphedema Of The Arm The affected limb may develop inflammation, infection, adipogenesis, and fibrosis of the tissue. The protein-concentrated fluid that accumulates inside the interstitial tissue may further block or make the drainage of the lymph fluid less efficient or even create an obstruction. Lymphedema of upper extremity causes pain, heaviness, skin hyperkeratosis, fibrosis, discomfort when wearing certain clothes and jewelry, cosmetic problems and limitation of daily activities for patients. It is common for lymphedema patients to experience depression, due to physical discomfort, emotional distress and lower quality of life. Anderson, Your safe choice Medical Center Specifications and Equipment The operating room is equipped with Mitaka microscopes, of which there are only four in Taiwan. They have a resolution of up to 16 million pixels and can magnify 42 times optically. They are very suitable for the anastomosis of lymphatic vessels and veins of 0.5 mm and are often used in lymphatic venous anastomosis, such as preoperative evaluation and intraoperative evaluation of the permeability of sutures, making the operation more stable and safe. Surgical Techniques 1 Lymphaticovenous Anastomosis, LVA LVA is an advanced minimally invasive super-microsurgical technique used to relieve lymphedema. During the procedure, Dr. Cheng will make small incisions, which expose lymphatic channels and small veins just beneath the skin. Learn more 2 Vascularized Lymph Node Flap Transfer, VLNT In some cases, surgery may be performed to alleviate swelling and reduce symptoms. Dr. Cheng has developed a unique technique that involves lymph node transfer. During the procedure, Dr. Cheng transfers lymph node flap to distal recipient site – dorsal wrist in the upper extremity or ankle in the lower extremity. Learn more 淋巴結移植治療乳癌術後淋巴水腫 Before 6 months later 8 years later 水腫2年 丹毒/蜂窩性組織炎2次 上臂改善：82％ 下臂改善：35％ 上臂改善：82％ 下臂改善：50％ 淋巴結移植治療乳癌術後淋巴水腫 Before 3 months later 8 years later 水腫10年 丹毒/蜂窩性組織炎30次 體重60 kg 上臂改善：5 ％ 下臂改善：5 ％ 體重 59 kg ( 減少1kg ) 上臂改善：60 ％ 下臂改善：10 ％ 體重56 kg ( 減少4 kg ) 淋巴結移植治療二期乳癌術後淋巴水腫 Before 24 months later 水腫2年 丹毒/蜂窩性組織炎3次 體重67kg 上臂改善：80 ％ 下臂改善：56 ％ 體重64 kg(減少3 kg) 淋巴結移植治療乳癌術後淋巴水腫 Before 3 months later 42 months later 水腫2年 丹毒/蜂窩性組織炎3次 上臂改善：25 ％ 下臂改善：15 ％ 上臂改善：90 ％ 下臂改善：90 ％ Patient Testimonials Patient Testimonials Play Video Share Whole Channel This Video Facebook Twitter Pinterest Tumblr Copy Link Link Copied Search video... Now Playing Lymphedema Treatment Testimony: Canadian Patient at A+ Surgery Clinic, Taipei, Taiwan"Video Content: 09:51 Play Video Now Playing Lymphedema Treatment Testimony:In addition to excellent medical care, also enjoys Taiwanese cuisine 04:27 Play Video Now Playing Mr. William from Australia 05:50 Play Video Recommended reading journal Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Lin CH, Ali R, Chen SC, Wallace C, Chang YC, Chen HC, Cheng MH. Plast Reconstr Surg. 2009 Apr;123(4):1265-75 https://www.ncbi.nlm.nih.gov/pubmed/19337095 Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes.. Cheng MH, Chen SC, Henry SL, Tan BK, Lin MC, Huang JJ. Plast Reconstr Surg. 2013 Jun;131(6):1286-98. https://www.ncbi.nlm.nih.gov/pubmed/23714790 Outcomes of Lymphedema Microsurgery for Breast Cancer-related Lymphedema With or Without Microvascular Breast Reconstruction. Engel H, Lin CY, Huang JJ, Cheng MH. Ann Surg. 2017 Jun 7 https://www.ncbi.nlm.nih.gov/pubmed/28594742 Greater Omental Lymph Node Flap for Upper Limb Lymphedema with Lymph Nodes-depleted Patient. Chu YY, Allen RJ Jr, Wu TJ, Cheng MH. Plast Reconstr Surg Glob Open. 2017 Apr 25;5(4):e1288. https://www.ncbi.nlm.nih.gov/pubmed/28507857 The Submental versus Groin Vascularized Lymph Node Transfer Flaps: A Head-to-Head Comparison of Surgical Outcomes for Breast Cancer Related Lymphedema Ho OA, Lin CY, Cheng MH. Plast Reconstr Surg Glob Open. 2018 [Epub ahead of print] Contact Dr. Cheng For A Consultation If you have Breast Cancer Related Lymphedema and would like to know more about the most advanced treatments, contact Dr. Cheng. Internationally recognized as a leading lymphedema specialist, Dr. Cheng can discuss treatment options, based on your individual case. Dr. Cheng is a member of the American Society of Reconstructive Microsurgery and has performed numerous VLN surgeries on breast cancer survivors and other lymphedema patients. Learn more

鄭明輝醫師完成了近千例淋巴水腫治療手術，是透過顯微淋巴結皮瓣移植手術及淋巴靜脈吻合術，成功治療最多淋巴水腫患者的醫師。他創新、獨特的手術方法及成果發表在許多國際知名期刊，贏得全球顯微重建外科界的認可和讚譽，吸引了無數的整形外科學者前來學習、交流，同時也有來自美國、加拿大、馬來西亞、大陸、瑞 典、澳洲、杜拜、沙烏地阿拉伯及坦尚尼亞等國家的病人前來接受治療。 Diagnosis of Lymphedema Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery 淋巴水腫的診斷 Diagnosis of Lymphedema 腹股溝淋巴結皮瓣移植及受體部位的限制、選擇、適應症。VGLN，腹股溝淋巴結; ISL，國際淋巴水腫學會; Tc-99，鎝-99。 資料來源： Cheng MH, Chen SC, Henry SL, Tan BK, Lin MC, Huang JJ. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes. Plast Reconstr Surg. 2013 Jun;131(6):1286-98.