Transplanting healthy lymph nodes from a donor site to restore lymphatic function in the affected limb — the surgical option for advanced or LVA-ineligible lymphedema.
VLNT (Vascularised Lymph Node Transfer) is a microsurgical procedure in which a group of healthy lymph nodes — along with their blood supply — is harvested from a donor site (groin, supraclavicular neck, omentum or lateral thorax) and transplanted to the affected limb. The transferred lymph nodes establish new drainage pathways and release growth factors that promote lymphangiogenesis (new lymphatic vessel formation) in the recipient area.
Lymphoscintigraphy, ICG lymphography and limb volume measurements. Assessment of donor site options and discussion of the surgical plan.
Donor lymph node flap harvested — its blood vessels dissected free. Recipient site prepared in the affected limb. Lymph node flap transferred and blood vessels joined microsurgically.
3–5 days hospital admission with vascular monitoring of the transferred flap for the first 48–72 hours.
Compression garment from day 1. CDT programme continued and adjusted over the post-operative months.
Improvement develops gradually over 6–18 months as new lymphatic connections form. Volume reduction, reduced heaviness and fewer infections are progressive.
This is the most important concern with VLNT. Dr. Thusay uses reverse lymphatic mapping (RLM) to precisely identify and protect the nodes that drain the donor site limb — ensuring only nodes that do NOT drain the leg are harvested from the groin. With this technique, donor site lymphedema risk is extremely low.
VLNT results are slower than LVA — peak improvement develops over 6–18 months. Early improvements in heaviness and cellulitis frequency may be noticed within weeks, but measurable limb volume reduction typically begins at 6 months.
Neither procedure is universally superior — they are indicated for different patient profiles. LVA is first-line for early lymphedema with patent lymphatics. VLNT is preferred for advanced lymphedema, fibrotic limbs or when LVA mapping shows no suitable lymphatic channels. Dr. Thusay recommends the appropriate option after thorough investigation.
Yes — in selected patients, VLNT at the root of the limb combined with LVA bypass vessels along the limb provides a comprehensive approach addressing both lymph node reconstruction and distal drainage.
Yes — compression garments are continued after VLNT as the lymphatic reconstruction develops. Many patients find they can progressively reduce the compression class over months as results improve.
Main risks: partial flap loss (rare), seroma at donor site, temporary pain at donor and recipient sites, and the low risk of donor site lymphedema (mitigated by reverse mapping). Dr. Thusay will review all risks in detail at the consultation.
In the first 48–72 hours post-operatively, the flap is monitored clinically and with a hand-held Doppler every 1–2 hours in the surgical ward. Any sign of vascular compromise is an emergency requiring immediate return to theatre — this is why a hospital stay of 3–5 days is required.
For Stage III lymphedema with significant fibrosis, conservative CDT remains the cornerstone of management — achieving volume reduction and skin care. However, surgical options (VLNT, liposuction for lymphedema) can achieve results that CDT alone cannot.
Dr. Pranav Thusay will personally assess your case and create a tailored plan.