Treatment Protocol

Say Goodbye to Compression Garments after Dr. Cheng’s Lymphedema Microsurgery

We are pleased to confirm that we have received your consultation.  We understand your personal situations and concerns to undergo the treatments overseas, also the differences of the medical systems between your country and Taiwan.  We will try our best to answer your questions upfront and make your visit to Taiwan as easy as possible if you decide to take the treatment by Dr. Ming-Huei Cheng at the Center of Lymphedema Microsurgery.  Please do not hesitate to email us should you have any questions or concerns anytime.

We will schedule your initial consultation with Dr. Cheng once you confirm your itinerary to Taiwan.  The lymphedema evaluation examinations (lymphoscintigraphy, CT, sonography, and MRI) will be arranged within 2- 3 days after your initial clinic.  Dr. Cheng will explain the details of diagnosis, grading, operations, options of recommendations, and experted outcomes once your evaluation exam results are being fully reviewed.  We will then schedule the surgical operation right away with you consent without any extra waiting time. You will receive the pre-operation consultation, evaluation exams, operation, and rehabilitation in the same trip.

If you receive lymphovenous anastomosis (usually in a side-to-end anastomosis fashion), the recommended hospitalization time is 3 days.  We would suggest that you take a minimal of 1 week stay in Taiwan.  We then will email or use messaging application such as WhatsApp Messenger, WeChat, Line to follow up with your post-operation conditions after you return to home.

The recommended hospitalization time for the vascularized lymph node transfer is 1 week for upper limb lymphedema and 2 weeks for lower limb lymphedema. As a precautionary measure, we suggest you stay in Taiwan at least for 3 weeks. After the operation, you will also undergo a progressive dangling protocol for lower limb lymphedema that you will be advised to return to normal activity as tolerated gradually, and all compression wrapping or garments are discontinued immediately at post-operative day 1.

Surgical outcomes are evaluated by patient’s subjective improvement, circumferential measurements, CT volumetric measurements (if applicable) the frequency of cellulitis episodes at a 12-months of follow up, and via patient reported health-related quality of life outcome metrics. The majority of patients feel immediate improvement with the limb softer and lighter in a week. 90% patients may have mean 45% circumferential reduction rate and decrease episodes of cellulitis. For those that show a limited response (circumferential reduction rate less than 10%), Tc-99  lymphoscintigraphy and ultrasound Doppler are used to workup potential etiologies. Based on these studies, progressive venous outflow stenosis from scarring of surrounding tissue is the most common mechanism for a limited response following VLNT. These patients are suggested to undergo a the revisional surgery 6–12 months after their initial surgery to remove the scar surrounding the venous outflow or to revise the venous anastomosis. At this time, excess flap skin paddle can be removed to improve the cosmetic appearance of the distal wrist or ankle and liposuction of the upper arm or thigh to remove the excess or fat tissue of proximal part. Decreasing edema and increasing pliability of the tissues following vascularized lymph node transfer frequently allow for complete removal of skin paddles postoperatively. Please see the pre-op and post-op photos at the “Gallery”.

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