在安德森內搜尋：

Am I A Candidate? Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Suggested Candidates For Lymphedema Surgery A full medical history and thorough physical exam are required for the initial clinic visit. The circumferential differentiation between the affected and unaffected limbs (in unilateral disease) will be the focus, and measured comprehensively during the physical exam. Who is eligible for lymphedema surgery? A complete history, complete examination and diagnosis of both the lymphedematous limb and the unaffected limb (unilateral disease) are required at the initial visit. Based on the research results, Dr. Cheng's lymphedema grading system can establish a diagnosis and formulate treatment plans for patients. 1 Suggested candidates for Lymphedema surgery are as follows: Lymphedema patients who aggressively receive rehabilitation for more than 6 months without significant improvement. Lymphatic obstruction present in lymphoscintigraphy. The difference of circumference between the affected and non-affected limbs is more than 10%. Cancer patients with the aforementioned indications without tumor recurrence or distant metastasis. Learn more 2 Indications for Vascularized Lymph Node Flap Transfer are as follows: Patients exhibiting a total obstruction on lymphoscintigraphy in late grade II, grade III, and IV. Patients without patent lymphatic ducts on indocyanine green lymphography. Learn more 3 Indications for Lymphovenous Anastomoses are as follows: 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 Lymphedema Treatment Options Accurate diagnosis and appropriate staging assessment are fundamental to the successful treatment of lymphedema. The conventional treatment methods often require the use of antibiotics, massage, and complex decongestive therapy including compression garments and bandages. Innovative surgical treatments have been emerging rapidly in the past 10 years, and the ground breaking vascularized submental lymph node (VSLN) or vascularized groin lymph node (VGLN) flap transfer to distal recipient site that invented by Dr. Cheng create a natural physiologic drainage conduit to alter excess lymphatic fluid buildup and revert side effects like those of tissue fibrosis and skin swelling. Dr. Cheng’s surgical treatment outcomes show significant improvements in the circumferential reduction rates of the affected limb circumference without the use of compression garments. Data source: Asuncion M, Cheng MH, et al. PRS Global Open. 2018;23;6(3):e1691. Cheng MH, et al. Plast. Reconstr. Surg. 2013;131(6):1286-98. A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. Patel KM, Lin CY, Cheng MH. Ann Surg Oncol. 2015 Jul;22(7):2424-30 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. 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

25年的手術經驗 跨足淋巴水腫 乳房重建 醫學美容 三大領域的權威 鄭明輝教授是一位經過國際認證的整形外科醫生，專長為顯微重建手術，被列為全球顯微重建外科領域最受歡迎的整形外科醫生之一。迄今已經完成2500多個顯微手術病例，包括頭頸部重建、乳房重建、顱內外動脈血管旁接手術、淋巴管靜脈吻合術和淋巴結皮瓣移植。 鄭教授在1997年完成林口長庚紀念醫院整形外科住院醫師6年的訓練，並升任整形外科主治醫師，於1998年在德州休斯頓的MD安德森癌症中心整形外科完成顯微外科研究員的訓練。西元2003年成為美國重建顯微外科學會會員，2009年起成為美國外科學院院士，2017年獲邀為密西根大學整形外科兼任教授後，每年於美國密西根大學進行示範解剖教學，並演講指導學生。 為什麼要選擇安德森？ 01. 由國際顯微整形外科權威 (前林口長庚醫院院長)領軍 02. 25年治療經驗，全球800萬排名前2%頂尖醫師科學家 03. ​醫療團隊皆有專業執照 全程麻醉專科醫師麻醉監控 04. 精細的醫學診斷 量身定製專業諮詢服務 05. 24小時專業護理師團隊照護獨立病房，溫馨舒適 醫學中心規格的設備與服務 ​淋巴水腫 L ymphedema surgery 院長親自執刀、以全台僅4台的Mitaka顯微鏡進行手術 ​，術後無需穿著壓力套 乳房重建 Breast reconstruction "自然波動感"獨家技術，堅持以「乳房重建」最高醫療規格做隆乳 醫學美容 Beauty treatments 提供雙眼皮手術、除皺拉提、抽脂身材雕塑等各項美容美體服務 ——— 美容醫學再進化 不只是凍齡，更要逆齡 國際顯微整形外科權威團隊， 結合美學、醫學科技 帶您重塑自我，美麗蛻變 熱門商品 ——— 客製化量身打造 自然、隱痕、安全 複合式微整形 + 全身精緻體雕 從此拍照免修圖，素顏見人不用怕 ​來到安德森，就像家一樣安心 門診時間 鄭明輝 院長 週二、週四及週五 ​ ​下午13:30-17:00 杜隆成 主任醫師 週一 ​ ​下午14:00-17:00 張豫苓 主任醫師 週三 ​ ​下午12:00-15:00

Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery 1 DR. CHENG The Journey of Dr.Cheng Dr. Cheng's Team Publications Presentations Visiting Professorships Awards News 2 PROCEDURES What is Lymphedema Upper Extremity Lymphedema What is Lymphedema of The Legs? Primary Lymphedema Diagnosis of Lymphedema Advanced Diagnostic Technology 3 CENTER Treatment Comparison Chart Am I A Candidate? Lymphovenous Anatomosis Vascularized Lymph Node Flap Transfer Cheng Lymphedema Grading Systems Lymphedema FAQ 4 GALLERY Treatment of Mild to Moderate Lymphedema Treatment of Moderate to Severe Lymphede Testimonials（Video & Letters） Post-Operative Care 5 PATIENT INFORMATION Make an Appointment Accommodation Information Travel Information Patient Rights About Lymphedema Microsurgery Dr. Cheng has been practicing Lymphedema microsurgery since 2000. He has invented some of the most advanced and effective surgical techniques to treat lymphedema. His ground-breaking innovation of vascularized submental lymph node (VSLN) and vascularized groin lymph node (VGLN) flap transfer to distal recipient site creates a physiologic drainage conduit to alter excess lymphatic fluid buildup and minimize the lymphedema associated side effects of tissue fibrosis and cellulitis. Dr. Cheng's lymphedema microsurgery outcomes show statistically significant circumferential reduction rates of affected limb circumference and impressive decreases in the episodes of cellulitis on the lymphedematous limb. His practice is the first in the world to immediately release patients from wearing compression garments postoperatively. Meet Dr. Cheng Ming-Huei Cheng MD, MBA, FACS, is a board certified plastic surgeon specialized in reconstructive microsurgery. Dr. Ming-Huei Cheng is listed among the most sought-after surgeons in the reconstructive microsurgery field. He has performed more than 2,000 microsurgical cases, including arm and leg reconstructions, head and neck reconstructions, breast reconstructions, extracranial-intracranial arterial bypasses, lymphovenous anastomosis and vascularized lymph node flap transfers. He finished a combined microsurgical and research fellow at Department of Plastic Surgery, MD Anderson Cancer Center, Houston, Texas in 1999. He is a member of the American Society for Reconstructive Microsurgery since 2003, a fellow of the American College of Surgeons since 2009, an international member of the American Society of Plastic Surgeons since 2012 and became an Adjunct Professor of the Department of Plastic Surgery at University of Michigan, USA in 2017. Learn more Dr. Cheng is Affiliated With 鄭教授淋巴水腫顯微外科手術學術里程碑 Dr.Cheng’s Academic Journey for Lymphedema Microsurgery 出處：取自《乳癌奇蹟治癒》方舟出版社 News Apr 24 The 10th World Symposium for Lymphedema Surgery (WSLS) was successfully concluded Apr 30, 2022 Congratulation! The Spanish version of Lymphedema Surgery textbook has been published Aug 12, 2020 Dr.Cheng gave A Virtual Visiting Professor Lecture at The University of California, Los Angeles (UCLA) 1 2 3

The Journey of Dr. Cheng Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Winner of the 2006 Godina Travel Fellow of American Society for Reconstructive Microsurgery award, Ming-Huei Cheng MD, MBA, FACS, is a board-certified plastic surgeon specialized in reconstructive microsurgery. Dr. Ming-Huei Cheng completed his General Surgery and Plastic Surgery residency training at Chang Gung Memorial Hospital in 1991-1997. He finished a combined microsurgical and research fellowship at the Department of Plastic Surgery, M.D. Anderson Cancer Center, Houston, Texas in 1999. He is a member of the American Society for Reconstructive Microsurgery since 2003, a Fellow of the American College of Surgeons since 2009, an international member of the American Society of Plastic Surgeons since 2012, and he became an Adjunct Professor of the Section of Plastic Surgery at University of Michigan, Ann Arbor, MI, the USA in 2017. Dr. Cheng is listed among the most sought-after surgeons in the reconstructive microsurgery field. He has been invited as a visiting professor to more than 30 world-renowned medical centers in the United States and other countries. He has authored a total of 233 peer-reviewed papers, 41 book chapters, and edited one lymphedema textbook (Principles and Practice of Lymphedema Surgery, 2016, Elsevier) and one head & neck reconstruction textbook (Resection and Reconstruction of Head & Neck Cancers, 2019, Springer). There is a total of 6,858 citations of his publications with the h-index of 44 at the Google Scholar on February 26, 2019 (https://scholar.google.com/citations ?user=KtfcDvcAAAAJ&hl=en). ​ Earlier in his career, Dr. Cheng extensively involved in extremity reconstruction and head and neck cancer reconstruction. He has explored and developed new methods to harvest an osteomyocutaneous peroneal artery combined (OPAC) flap for head and neck reconstruction. Recently, his focus of clinical and research work has been on breast reconstruction and lymphedema microsurgery. In breast reconstruction, Dr. Cheng developed a modified nipple reconstruction technique using autologous rib cartilage, along with the areola tattooing to achieve a symmetrical appearance. He was the first in the world to combine breast reconstruction and breast augmentation procedures by using split DIEP flaps. Such combined treatment does not only allow the patient to have breast reconstruction after mastectomy but also improves the aesthetic outcome of the contralateral breast at the same time. For managing extremity lymphedema, he invented to utilize distal recipient site for vascularized lymph node flap transfer, together with related research on the mechanism of vascularized lymph node transfer, which he had been working on since 2000. He has trained many domestic and international well-known surgeons such as Drs. Joseph Dayan and Robert Allen Jr. at Memorial Sloan Kettering Cancer Center, Dung Nguyen at Stanford University, Ketan Patel at the University of Southern California, Dhruv Singhal at BIDMC/ Harvard Medical School, and Wei-Fan Chen at Cleveland Clinic to practice this vascularized lymph node transfer technique for their breast cancer-related lymphedema patients. Dr. Cheng is a well-known reconstructive microsurgeon in the international medical society. He was a keynote lecturer, panelist, and invited speaker in numerous international meetings. He has trained 95 residents and 100 international fellows and had 925 international visitors in the past 20 years. Dr. Cheng was honored to be selected as the 2006 Godina Traveling Fellow of the American Society for Reconstructive Microsurgery (the first one from Asia) to visit 13 renown institutes in the world and Zamboni Visiting Professor of the American Society for Reconstructive Microsurgery in 2016 and had the opportunity to visit 5 more famous institutes in the United States. Dr. Cheng received the Outstanding Alumni Award from the Chung Shun Medical University and Distinguished Alumni Award from Chang Gung University in 2008 and 2013, respectively. He's been named a top reviewer in Publons' Global Peer Review Awards 2018. Dr. Cheng has championed the collaboration between the Taiwan Society of Plastic Surgery (TSPS) and the American Society of Plastic Surgeons (ASPS). His vision is to raise the recognition and visibility of TSPS members at the international community and to expose the junior doctors and surgeons to the outside world with most learning opportunities through the alliance and partnership with ASPS. He also hosted the first Asian Symposium for Breast Plastic and Reconstructive Surgery in 2009. It has been held annually for 10 years consecutively since then. Several other international events that he held, to name a few, was the World Symposium on Lymphedema Surgery in 2013, 2016 and 2019. Dr. Cheng founded the Taiwan Breast Reconstruction Society (TBRS) in 2002. The mission of TBRS is to unite and connect patients with breast cancer and to offer support and encouragement for each other. With increasing visibility and outstanding of the accomplishments of TBRS, more and more volunteers including doctors and nurses have joined to serve and help cancer patients throughout the years. As an advocate in fighting and raising the awareness of breast cancer, and supporting breast reconstruction for women in Taiwan, Dr. Cheng promoted the collaboration between TBRS and Avon Cosmetics Company to establish a "Taiwan Breast Reconstruction Fund (TBRF)" in 2008. This charitable fund is to provide financial aid to the women who are in the need of breast reconstruction surgery but cannot afford it. So far, TBRF has sponsored more than 400 breast cancer patients for the breast reconstruction costs via the application process with this fund. He and his team of TBRF successful hosted the 7th Global Chinese Breast Cancer Organizations Alliance with more than 500 participants in Taoyuan in May 2018. Dr. Cheng has consistently received support with 20 research projects from the Ministry of Science and Technology and 22 projects from Chang Gung Memorial Hospital and published 39 basic research papers, including 4 in Biomaterials (SCI; IF = 10.27; Engineering, Biomedical 1/78), one in Adv Mater. 2015 Jan;27(1):138-44. (SCI; IF = 25.80; Materials science, multidisciplinary 8/285) and 3 in Tissue Engineering (SCI; IF = 6.51, Cell and Tissue Engineering 2/26). He further established a "Center for Tissue Engineering" for advanced translational research at Chang Gung Memorial Hospital to conduct in-depth research projects and ultimately to deliver the best plastic and reconstructive surgery outcomes in 2014. Throughout his professional years, he has received 20 patents. (3 US patents and 17 Taiwan patents). ​ Academic Achievements Winner of the 2006 Godina Travel Fellow of American Society for Reconstructive Microsurgery award, Ming-Huei Cheng MD, MBA, FACS, is a board-certified plastic surgeon specialized in reconstructive microsurgery. Dr. Ming-Huei Cheng completed his General Surgery and Plastic Surgery residency training at Chang Gung Memorial Hospital in 1991-1997. He finished a combined microsurgical and research fellowship at the Department of Plastic Surgery, M.D. Anderson Cancer Center, Houston, Texas in 1999. He is a member of the American Society for Reconstructive Microsurgery since 2003, a Fellow of the American College of Surgeons since 2009, an international member of the American Society of Plastic Surgeons since 2012, and he became an Adjunct Professor of the Section of Plastic Surgery at University of Michigan, Ann Arbor, MI, the USA in 2017. Dr. Cheng is listed among the most sought-after surgeons in the reconstructive microsurgery field. He has been invited as a visiting professor to more than 30 world-renowned medical centers in the United States and other countries. He has authored a total of 233 peer-reviewed papers, 41 book chapters, and edited one lymphedema textbook (Principles and Practice of Lymphedema Surgery, 2016, Elsevier) and one head & neck reconstruction textbook (Resection and Reconstruction of Head & Neck Cancers, 2019, Springer). There is a total of 6,858 citations of his publications with the h-index of 44 at the Google Scholar on February 26, 2019 (https://scholar.google.com/citations ?user=KtfcDvcAAAAJ&hl=en). ​ Earlier in his career, Dr. Cheng extensively involved in extremity reconstruction and head and neck cancer reconstruction. He has explored and developed new methods to harvest an osteomyocutaneous peroneal artery combined (OPAC) flap for head and neck reconstruction. Recently, his focus of clinical and research work has been on breast reconstruction and lymphedema microsurgery. In breast reconstruction, Dr. Cheng developed a modified nipple reconstruction technique using autologous rib cartilage, along with the areola tattooing to achieve a symmetrical appearance. He was the first in the world to combine breast reconstruction and breast augmentation procedures by using split DIEP flaps. Such combined treatment does not only allow the patient to have breast reconstruction after mastectomy but also improves the aesthetic outcome of the contralateral breast at the same time. For managing extremity lymphedema, he invented to utilize distal recipient site for vascularized lymph node flap transfer, together with related research on the mechanism of vascularized lymph node transfer, which he had been working on since 2000. He has trained many domestic and international well-known surgeons such as Drs. Joseph Dayan and Robert Allen Jr. at Memorial Sloan Kettering Cancer Center, Dung Nguyen at Stanford University, Ketan Patel at the University of Southern California, Dhruv Singhal at BIDMC/ Harvard Medical School, and Wei-Fan Chen at Cleveland Clinic to practice this vascularized lymph node transfer technique for their breast cancer-related lymphedema patients. Dr. Cheng is a well-known reconstructive microsurgeon in the international medical society. He was a keynote lecturer, panelist, and invited speaker in numerous international meetings. He has trained 95 residents and 100 international fellows and had 925 international visitors in the past 20 years. Dr. Cheng was honored to be selected as the 2006 Godina Traveling Fellow of the American Society for Reconstructive Microsurgery (the first one from Asia) to visit 13 renown institutes in the world and Zamboni Visiting Professor of the American Society for Reconstructive Microsurgery in 2016 and had the opportunity to visit 5 more famous institutes in the United States. Dr. Cheng received the Outstanding Alumni Award from the Chung Shun Medical University and Distinguished Alumni Award from Chang Gung University in 2008 and 2013, respectively. He's been named a top reviewer in Publons' Global Peer Review Awards 2018. Dr. Cheng has championed the collaboration between the Taiwan Society of Plastic Surgery (TSPS) and the American Society of Plastic Surgeons (ASPS). His vision is to raise the recognition and visibility of TSPS members at the international community and to expose the junior doctors and surgeons to the outside world with most learning opportunities through the alliance and partnership with ASPS. He also hosted the first Asian Symposium for Breast Plastic and Reconstructive Surgery in 2009. It has been held annually for 10 years consecutively since then. Several other international events that he held, to name a few, was the World Symposium on Lymphedema Surgery in 2013, 2016 and 2019. Dr. Cheng founded the Taiwan Breast Reconstruction Society (TBRS) in 2002. The mission of TBRS is to unite and connect patients with breast cancer and to offer support and encouragement for each other. With increasing visibility and outstanding of the accomplishments of TBRS, more and more volunteers including doctors and nurses have joined to serve and help cancer patients throughout the years. As an advocate in fighting and raising the awareness of breast cancer, and supporting breast reconstruction for women in Taiwan, Dr. Cheng promoted the collaboration between TBRS and Avon Cosmetics Company to establish a "Taiwan Breast Reconstruction Fund (TBRF)" in 2008. This charitable fund is to provide financial aid to the women who are in the need of breast reconstruction surgery but cannot afford it. So far, TBRF has sponsored more than 400 breast cancer patients for the breast reconstruction costs via the application process with this fund. He and his team of TBRF successful hosted the 7th Global Chinese Breast Cancer Organizations Alliance with more than 500 participants in Taoyuan in May 2018. Dr. Cheng has consistently received support with 20 research projects from the Ministry of Science and Technology and 22 projects from Chang Gung Memorial Hospital and published 39 basic research papers, including 4 in Biomaterials (SCI; IF = 10.27; Engineering, Biomedical 1/78), one in Adv Mater. 2015 Jan;27(1):138-44. (SCI; IF = 25.80; Materials science, multidisciplinary 8/285) and 3 in Tissue Engineering (SCI; IF = 6.51, Cell and Tissue Engineering 2/26). He further established a "Center for Tissue Engineering" for advanced translational research at Chang Gung Memorial Hospital to conduct in-depth research projects and ultimately to deliver the best plastic and reconstructive surgery outcomes in 2014. Throughout his professional years, he has received 20 patents. (3 US patents and 17 Taiwan patents). ​ International Invited Lectures Invited Panelist and Moderator Instructional Courses 1. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Third conference, Group for Advance Breast Reconstruction surgeons. Beijing, China, October 12, 2008. 2. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, October 28, 2008. 3. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota, October 31, 2008. 4. Vascular Groin Lymph node transfer for postmastectomy upper extremity lymphedema. First Asian Symposium for Breast Plastic and Reconstructive Surgery in Taoyuan, Taiwan, May 30-31, 2009. 5. Management of Post-Mastectomy Upper Extremity Edema. 1st Mayo Clinic/Chang Gung University Medical College Symposium in Reconstructive Microsurgery in Rochester, Minnesota, June 4-7, 2009. 6. Vascularized Groin Lymph Node Transfers for Treatment of Upper Extremity Lymphedema. Techniques in Flap Dissection with Cadaver Workshop Program in Dallas, Texas, July 11-12, 2009. 7. Vascularized Groin Lymph Node Transfers for Treatment of Upper Extremity Lymphedema. The University of Texas MD Anderson Cancer, Houston, Texas, July 13-14, 2009. 8. Vascularized Groin Lymph Node Transfers for Treatment of Upper Extremity Lymphedema. University of South California, Los Angeles, California, July 16-17, 2009. 9. Vascularized groin lymph node transfer for postmastectomy upper extremity lymphedema. The third Shenzhen Conference of Breast Cancer in Shenzhen, China, August 27-30, 2009. 10. Vascularized groin lymph node transfer for postmastectomy upper extremity lymphedema. 2009 Taipei International Breast Cancer Symposium, Taipei, Taiwan, September 12-13, 2009. 11. Vascularized Groin Lymph Node Transfer for Postmastectomy Upper Limb Lymphedema. Asia Breast Cancer Collaborative Group Meeting 2010, Guangzhou International Breast Cancer Symposium in Guangzhou, China, September 3-5, 2010. 12. Vascular Groin Lymph Node Transfer for Post Mastectomy Lymphedema. The 16th World Congress of the International Confederation for Plastic, Reconstructive and Aesthetic Surgery, Vancouver, Canada, May 21-27, 2011. 13. Vascularized LN Transfer for Lymphedema Treatment. The 4th CCH International Breast Cancer Conference, Taichung, Taiwan, August 13, 2011. 14. Lower Limb Lymphedema Treatment with Vascularized Submental Lymph Nodes Flap Transfer. APAGE 2013 Laparoscopic Gynecologic Oncology Surgery & Hands-on Animal Workshop, Shanghai, China, March 21-23, 2013. 15. Evaluation of the Effect of Vascularized Lymph Nodes Transfer on Lymphatic Drainage and Local Immune Function in an Experimental Rat Lymphedema Model. 2013 International Symposium on Surgical Treatment of Lymphedema, Taoyuan, Taiwan, April 10-20, 2013. 16. Vascularized Groin Lymph Node Flap Transfer for Postmastectomy Upper Limb Lymphedema: The Flap Anatomy, Recipient Sites, and Outcomes. 2013 International Symposium on Surgical Treatment of Lymphedema, Taoyuan, Taiwan, April 10-20, 2013. 17. Vascularized Submental Lymph Node Flap Transfer for the Treatment of Lower Extremity Lymphedema: Anatomical Study and Clinical Applications. 2013 International Symposium on Surgical Treatment of Lymphedema, Taoyuan, Taiwan, April 10-20, 2013. 18. Vascularized lymph node flap transfer. Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC, USA. February 6, 2014. 19. Submental lymph node transplantation for lymphedema. Research and Surgical Perspectives in Lymphedema, Brussel, Belgium, March 3, 2014. 20. Vascularized lymph nodes flaps for lymphedema - Taiwan style. 3rd International Symposium on Lymphedema Surgical Treatment, Barcelona, Spin. March 5, 2014. 21. Vascularized lymph node transfer for upper and lower limbs lymphedema - recipient site selection and mechanism. The 2nd Meeting of Asian Pacific Federation of Societies for Reconstructive Microsurgery (APFSRM) 2014, Buyeo, Korea. July 4, 2014. 22. Vascularized Lymph Node Flap for Breast Cancer related Lymphedema. The 5th International Oncoplastic Breast Surgery Symposium, Guangzhou, China, September 20, 2014. 23. Vascularized Lymph Node Transfer for Upper and Lower Limbs Lymphedema-Recipient Site Selection and Mechanism. The 6th Asian Symposium for Breast Reconstructive Surgery, Bali, Indonesia, October 21, 2014. 24. Vascularized lymph node flap transfer for treatment of lymphedema. The 4th Congress of the World Association for Plastic Surgeons of Chinese Descent, November 7, 2014. 25. Vascularize Lymph Node Flap Transfer for Upper and Lower Limb Lymphedema. The 58th Annual Meeting of Japan Society of Plastic and Reconstructive Surgery, Kyoto, Japan. April 8 to 10, 2015. 26. Submental Lymph Node Transfer. The Chicago Breast & Lymphedema Symposium, Chicago, Illinois, September 19-20, 2015. 27. The Mechanism of Vascularized Lymph Node Transfer for Lymphedema- Natural Lymphatico-venous Drainage. The 5th World Symposium for Lymphedema Surgery, Chang Gung Linkou Medical Center, Taoyuan, April 27-29, 2016, 28. Recent Advances in Lower Limb Lymphedema, The 17th Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapy (APAGE) Annual Congress 2016, Taipei International Convention Center, Taiwan, November 4-6, 2016. 29. Vascularized lymph nodes flap transfers for upper and lower limbs lymphedema, the Orange County Society of Plastic Surgeons meeting, Los Angles, USA, November 7, 2016. 30. Lymph Node Transplant - Groin/Submental, The first annual Lymphedema Symposium at BIDMC/Harvard Medical School, Boston, USA, November 3, 2017. 31. Submental LNT, WSRM/ASLS Joint Symposium on Lymphatic Surgery, January 12, 2018. 32. Vascularized Lymph Node Transfer for Treatment of Lymphedema, 1st Annual USC Multi-Disciplinary Approach to Lymphedema and Related Disorders Symposium, June 9, 2018. 29. Vascularized lymph nodes flap transfers for upper and lower limbs lymphedema, the Orange County Society of Plastic Surgeons meeting, Los Angles, USA, November 7, 2016. 30. Lymph Node Transplant - Groin/Submental, The first annual Lymphedema Symposium at BIDMC/Harvard Medical School, Boston, USA, November 3, 2017. 31. Submental LNT, WSRM/ASLS Joint Symposium on Lymphatic Surgery, January 12, 2018. 32. Vascularized Lymph Node Transfer for Treatment of Lymphedema, 1st Annual USC Multi-Disciplinary Approach to Lymphedema and Related Disorders Symposium, June 9, 2018. Vascularized groin lymph node transfer for postmastectomy lymphedema. Panel: Surgical options, techniques and outcomes for postoperative extremity lymphedema, with David Chang, and Isao Koshima. 2010 Annual Meeting, American Society for Reconstructive Microsurgery, Boca Raton, Florida, January 11, 2010. Post mastectomy lymphedema - does anything work? 2010 Annual Meeting, American Society of Plastic Surgeons, Toronto, Canada, October 5, 2010. Lymphedema treatment. 2011 Annual Meeting, American Society for Reconstructive Microsurgery in Cancun, Mexico, January 17, 2011. Lymphedema. The 16th World Congress of the International Confederation for Plastic, Reconstructive and Aesthetic Surgery, Vancouver, Canada, May 21-27, 2011. Vascularized Lymph Node Transfer for the Treatment of Lymphedema: Controversies in Safety and Efficacy. 2013 Annual Meeting, American Society for - Reconstructive Microsurgery, Naples, Florida. January 12-15, 2013. Lymphedema Section. Lymph Node Transfer: Taiwan Style. 2013 Bi-Annual Meeting, World Society for Reconstructive Microsurgery, Chicago, Illinois. July 11-13, 2013. New Technologies in Lymphedema .2013 Annual Meeting, American Society of Plastic Surgeons, San Diego, California, October 11-15, 2013. Vascularized Lymph Node Transfer: Taiwan Style. Annual Meeting, American Society for Reconstructive Microsurgery, Kauai, Hawaii. January 11-14, 2014. Pathophysiology of Lymphedema: current evidences. 3rd International Symposium on Lymphedema Surgical Treatment, Barcelona, Spin. March 5, 2014. Lymphnode Transfer in the Breast Cancer Patient. 2014 The Plastic Surgery Meeting, Chicago, Illinois, October 14, 2014. Decision Making in Lymphatic Surgery. 2015 Annual Meeting, American Society for Reconstructive Microsurgery, Atlantis, Paradise Island, Bahamas. January 24, 2015. American Society of Lymphatic Surgery Scientific Session. 2015 American Society for Reconstructive Microsurgery, Atlantis, Paradise Island, Bahamas. January 26, 2015. Master Class: Lymphedema. 2015 World Society for Reconstructive Microsurgery, Mumbai, India. March 19–22, 2015. Surgical Treatment of Lymphedema. The Chicago Breast & Lymphedema Symposium, Chicago, Illinois, September 19-20, 2015 Lymph Node Transfer: How & Why I Do It This Way. The Chicago Breast & Lymphedema Symposium, Chicago, Illinois, September 19-20, 2015 Decision Making in Lymphatic Surgery. 2016 Annual Meeting, American Society for Reconstructive Microsurgery, Scottsdale, Arizona, USA. January 16, 2016. Lymphatic Surgery: Which Operation for Whom? 2016 Annual Meeting, American Society for Reconstructive Microsurgery, Scottsdale, Arizona, January 19, 2016. Lymphedema: Everything You Ever Wanted To Know? American Association of Plastic Surgeons and Plastic Surgery Research Council Joint Meeting, New York, May 19 - 22, 2016. What's New in Lymphatic Surgery. The Chicago Breast & Lymphedema Symposium, Chicago, Illinois, September 16-17, 2016. Lymphedema 1: Knowns and unknowns in lymphatic surgery: Masters' perspectives, 9th Congress of World Society for Reconstructive Microsurgery, Seoul, Korea, June 16, 2017. Imaging - How I Do It, The first annual Lymphedema Symposium at BIDMC/Harvard Medical School, Boston, USA, November 4, 2017. An Algorithmic Approach to Deciding which Lymphedema Surgery a Patient Needs, 2018 American Society for Reconstructive Microsurgery, Phoenix, Arizona, USA. January 14, 2018. Moderator, Pre & Postop Care for Lymphedema Surgery, The Chicago Breast Symposium and 7th World Symposium on Lymphedema Surgery, Chicago, Illinois, April 26, 2018. Lymphedema Surgery II, The Chicago Breast Symposium and 7th World Symposium on Lymphedema Surgery, Chicago, Illinois, April 27, 2018. Changes in Lymphedema Surgery Over Time, The Chicago Breast Symposium and 7th World Symposium on Lymphedema Surgery, Chicago, Illinois, April 27, 2018. Cheng MH. Moderator, Keynote Lecture, the 8th World Symposium for Lymphedema surgery, Taiwan, Chang Gung Linkou Medical Center, Taoyuan, April 25, 2019. Cheng MH. Panelist, Surgical Technique and Outcomes of Variable Donor Lymph Node Flaps, the 8th World Symposium for Lymphedema surgery, Taiwan, Chang Gung Linkou Medical Center, Taoyuan, April 25, 2019. Tinhofer I, Cheng MH. Impacts of Arterial Ischemia or Venous Occlusion on Vascularized Groin Lymph Nodes in A Rat Model, April 26, 2019 Koide S, Cheng MH* et al. Delayed Primary Retention Suture: A new technique to inset Vascularized Submental Lymph Node Transfer, April 26, 2019 Rodriguez JR, Cheng MH* Clinical Features, Microbiological Epidemiology and Recommendations of Management for Cellulitis in Extremity Lymphedema, April 26, 2019 Voravitvet TY, Cheng MH* et al. Lymphedema Microsurgery Reduces the Rate of Implant Removal for Patients Who Have Pre-existing Lymphedema and Total Knee Arthroplasty for Knee Osteoarthritis, April 26, 2019 Cheng MH*. Intra-abdominal Chylovenous Bypass Treats Retroperitoneal Lymphangiomatosis, April 26, 2019 Pappalardo M, Cheng MH". Lymphoscintigraphy for the Diagnosis of Extremity Lymphedema: Current Controversies Regarding Protocol, Interpretation and Clinical Application, April 26, 2019 1. NEW! Vascularized Lymph Node Flap Transfer for Upper and Lower Limb Lymphedema. 2013 Annual Meeting of American Society of Plastic Surgeons, San Diego, California, October 11-15, 2013. 2. Lymph node transfer: Chang Gung Style. 2013 Annual Meeting of American Society of Plastic Surgeons, San Diego, California, October 11-15, 2013. 3. Lymph node Transfer - Breast Applications. 2014 Annual Meeting of American Society of Plastic Surgeons, Chicago, Illinois, October 14,2014. 4. Vascularized Lymph Node Flap Transfer for Upper and Lower Limb Lymphedema. 2014 Annual Meeting of American Society of Plastic Surgeons, Chicago, Illinois, October 14, 2014. 5. Vascularized Lymph Node Flap Transfer for Upper and Lower Limb Lymphedema. 2015 Annual Meeting of American Society of Plastic Surgeons, Boston, Massachusetts, October 16, 2015. 6. Lymph node Transfer - Breast Applications. 2015 Annual Meeting of American Society of Plastic Surgeons, Boston, Massachusetts, October 17, 2015. 7. Advanced lymphatic surgery: How I do it. 9th Congress of World Society for Reconstructive Microsurgery, Seoul, Korea, June 16, 2017. 8. Supermicrosurgery hands-on course, the Department of Plastic Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, May 5, 2018. 9. Supermicrosurgery hands-on course, the Department of Plastic Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, November 17, 2018. 10. Supermicrosurgery hands-on course, the Department of Plastic Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, November 24, 2018. 11. Current Surgical Approach for Upper Extremity Lymphedema, 2020 American Association for Hand Surgery Annual Meeting, Ft. Lauderdale, Florida, USA. January 10, 2020. Co-chairman, 8th World Symposium for Lymphedema surgery International Workshop or Live Surgery (Live Surgery) Vascularized Submental Lymph Node Transfer, the 8th World Symposium for Lymphedema surgery, Taiwan, Chang Gung Linkou Medical Center, Taoyuan, April 25

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. Case Before Surgery: This is a 61-year-old female who had suffered from breast cancer-related lymphedema of the right upper extremity for 10 years after mastectomy, axillary 19 lymph nodes dissection, and radiotherapy. With the combined use of compression garments and the treatment of complete decongestive therapy, she had developed 2 episodes of cellulitis per year. After Surgery: At 75- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 40% above and below the elbow, respectively. Before Surgery: A 53-year-old patient with grade II breast cancer-related lymphedema of the right upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 2 episodes of cellulitis per year and was refractory to conservative decongestive therapy. After Surgery: At 36- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 85% above and below the elbow, respectively. Before Surgery: A 56-year-old patient with grade IV breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 5 episodes of cellulitis per year and was refractory to conservative decongestive therapy. After Surgery: At 29- months follow-up, the circumferential reduction rates of the affected limb circumference without the use of compression garments were 100% and 65% above and below the elbow, respectively. Before Surgery: A 70-year-old patient with grade III breast cancer-related lymphedema of the left upper extremity for 36 months after modified radical mastectomy, axillary lymph node dissection, and radiation. She developed 1 episodes of cellulitis per year and was refractory to conservative decongestive therapy. After Surgery: At the 50-months follow-up, the reduction rate was 80% above the elbow and 45% below the elbow without the use of a compression garment. 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 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. 鄭教授淋巴水腫顯微外科手術學術里程碑 Dr.Cheng’s Academic Journey for Lymphedema Microsurgery 出處：取自《乳癌奇蹟治癒》方舟出版社 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

What is Lymphedema of The Legs? Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Lower Extremity Lymphedema? The lower extremity lymphedema has a 10-49% occurrence in patients who suffer from gynecological cancers with pelvic lymph node dissection and radiation. Higher body mass index, a greater number of pelvic lymph node removal, and radiation are the top risk factors for lower extremity lymphedema caused by parasite infection (Filariasis). Primary lymphedema patients with unknown etiology for symptoms and signs are categorized by their ages of onset as congenital (less than 2 years), lymphedema praecox (2- 35 years), and lymphedema tadar (older than 35 years). The incidence is higher after cancer resection and lymph node dissection in vulva cancer followed by cervical and ovarian cancer. Recently, sentinel lymph node biopsy was selectively applied in gynecological cancer surgery to reduce the lower limb lymphedema. ​ Symptoms of Leg Lymphedema Lymphedema then presents as chronic changes and swelling of the tissue and is often associated with adipogenesis or fibrotic changes in the lower limb as well. Severe fibrosis occurs with long-standing lymphedema due to the accumulation of protein-rich fluid in the interstitial spaces coupled with inflammation repeated bouts of cellulitis. It is common for lymphedema patients to experience depression, due to the physical discomfort, emotional distress and lowered quality of life. Diagnosis of Leg Lymphedema Dr. Ming-Huei Cheng developed a Cheng’s Lymphedema Grading tool to assess the severity of extremity lymphedema. Cheng Lymphedema Grading System is currently the most common used measurement, it is based on not only subjective criteria and clear objective findings that could facilitate discussions and meaningful comparison of the treatment proposed. The circumferential measurement is an objective analysis tool to assess the severity of lymphedema commonly by comparing the circumferential differences between the lymphedematous limb and the normal limb. Lymphoscintigraphy, computed tomography (CT), indocyanine green (ICG) lymphography, and magnetic resonance imaging (MRI) are other key diagnostic devices to determine the severity of lymphedema. The lymphoscintigraphy has been reported as the most effective indicator with 96% sensitive and 100% specific conclusion for diagnosing extremity lymphedema. The Taiwan Lymphoscintigraphy Staging systems was published in 2018 at Annals of Surgery. Lymphoscintigraphy computed tomography (CT) magnetic resonance imaging (MRI) indocyanine green (ICG) lymphography Treatment of Lower Extremity Treatments of lymphedema are aimed to control infection, to reduce the swelling of the extremity and to improve the quality of life. Basic treatments of lymphedema start with conservative physical therapy, including manual lymphatic drainage and compression bandage-centered decongestive lymphatic therapy. The efficacy of conservative physical therapy presents only when the patients are compliant with the treatment program. However, it also carries risks of intravascular cancer metastasis and thrombosis formation. Surgical treatments are indicated when first line conservative measures fail and when patients present with late stage disease. There are two main categories of surgical treatment: excisional and physiologic procedures. Excisional procedures are essentially a surgical reduction of excess fibro-adipose tissue in the affected limb while physiologic procedures reconstruct the lymphatic system to improve physiologic drainage. Surgical treatments are also “be cure and control”, the goals of treatment are similarly preventing progression of disease and reducing morbidities. Debulky surgery and circumferential suction-assisted lipectomy can be performed to reduce the severely, non-pitting lymphedematous extremity. More technical demanding surgeries, such as lymphaticovenous anastomosis and Free vascularized lymph node transfer The basic physiologic mechanism of the vascularized lymph node flap is that lymph is absorbed by the transferred lymph nodes and drained into a donor vein through natural lymphaticovenous connections inside a flap. The arterial flow from the recipient artery to the vascularized lymph node flap provides the driving force for venous return and hence, continuous lymph drainage. We report the transfer of a vascularized submental lymph node flap to the ankle is a novel approach for the effective treatment of lower extremity lymphedema. There was no donor site morbidity. At a mean follow-up of 8.7 ± 4.2 months, the mean reduction of the leg circumfer- ence was 64±11.5% above the knee, 63.7±34.3% below the knee and 67.3±19.2% above the ankle. All of the patients did not use compression garments post-operatively! 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. Recommended reading journal 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. https://www.ncbi.nlm.nih.gov/pubmed/22516659 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. https://www.ncbi.nlm.nih.gov/pubmed/26495226 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. https://www.ncbi.nlm.nih.gov/pubmed/29572824 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. https://www.ncbi.nlm.nih.gov/pubmed/30020232 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

Lymphovenous Anatomosis (LVA) Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Lymphedema A common problem cancer survivors face is post-operative lymphedema. Lymphedema is caused by excess fluid that collects in the body’s tissue, causing swelling (edema). The symptoms are typically swollen limbs due to lymphatic circulation blockage. Some patients may also experience skin problems (eczema, rough skin, unidentified protrusion), repeated cellulitis or toe mold infection. Award winning plastic surgeon Dr. Cheng specializes in reconstructive surgery and is an expert in the lymphovenous anatomosis (LVA) technique, a minimally-invasive microsurgery procedure that can address the symptoms of lymphedema. Since lymphedema is not always treatable with non-surgical rehabilitation, LVA surgery can greatly improve the condition. 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. Case 57-year-old female with left upper limb lymphedema for 12- months Before Surgery: This is a 57-year-old female with left upper limb lymphedema for 12- months after left mastectomy and radiation. After Surgery: At a 15- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 86% and 100% above the elbow and below the elbow, respectively. 56-year-old female with right upper limb lymphedema for 10- months Before Surgery: This is a 56-year-old female with right upper limb lymphedema for 10- months after right mastectomy and axillary 31 lymph nodes dissection and radiation. After Surgery: At a 36- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. 39-year-old female with left upper limb lymphedema for 6- months Before Surgery: This is a 39-year-old female with left upper limb lymphedema for 6- months after left mastectomy and axillary 31 lymph nodes dissection and radiation. After Surgery: At a 3- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 35% and 60% above the elbow and below the elbow, respectively. Before Surgery: This is a 64-year-old female with left upper limb lymphedema for 12- months after right mastectomy and axillary lymph nodes dissection and radiation. After Surgery: At a 36- months of follow-up, the circumferential reduction rates of the affected limb without the use of compression garments were 100% and 100% above the elbow and below the elbow, respectively. 術前（左）： 這是一名64歲的女性，右乳房切除術和腋窩淋巴結清掃術和放射治療後左上肢淋巴水腫12個月。 術後（右）： 接受淋巴管靜脈吻合術後，在36個月的隨訪中，不使用壓力袖套，患肢的手臂周長減少率分別在肘部和肘部以上100％和100％。 Candidates for LVA Cancer patients that have had lymph nodes removed due to the disease Patients who have not experienced relief from non-surgical therapies Cheng’s grading I, and early grade II lymphedema Partial obstruction on lymphoscintigraphy Patent lymphatic ducts on ICG lymphography Determining a Treatment Plan For patients with grade I to IV lymphedema, an individualized treatment plan is determined based on imaging studies. Patients with grade I and early II lymphedema will undergo a lymphodynamic evaluation by indocyanine green (ICG) lymphography. The ICG injection allows Dr. Cheng to evaluate the presence and location of open, functioning lymphatic channels or dermal backflow (obstruction of lymphatic flow). This type of image study is performed via injections into the second and fourth web spaces of the fingers or toes. Images are obtained at 5 minutes, and then again after 20 hours. These image studies enable Dr. Cheng to create a customized treatment plan for each patient depending on their degree of lymphedema. How Does LVA Surgery Work? The most advanced, minimally invasive super-microsurgical techniques relieve lymphedema through small incisions (around 3cm). Preoperatively, ICG lymphography is used to map the lymphatic system on the skin and locate the incisions. Once the lymphatic channel and a suitable vein have been identified and prepared, a connection between them is created to give the lymphatic fluid an alternative route to escape from the affected area. The lymph fluid will then drain effectively through the vein. Surgical Techniques If LVA surgery is chosen for a patient, Dr. Cheng’s preference is to perform one or two Side-To-End (lymph-to-vein) anastomosis. Using super-microsurgery techniques, Dr. Cheng performs the LVA surgery so that the lymph can drain into the vein from both proximal and distal directions. Into the planned incision, allowing the lymphatic channels to be easily detected. The can then be seen draining from the lymphatic channel into the vein, confirming LVA surgery success. ICG fluorescence may also be used to verify a successful LVA surgery. Side-to-end (Cheng’s Technique) End-to-end (Koshima’s Technique) End-to-end (A and B) end-to-side (C and D) anastomosis are shown. The decision to perform one versus another is based on the intrinsic functionality of the native lymphatic and the inherent pumping mechanism. If the venous pressure is greater than the lymphatic pressure, the blood is regurgitated and causes the anastomosis thrombosis (B and D). Bidirectional lymph will flow into the vein in a side-to-end fashion (C and 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 63. Patency test of the side-to-end lymphovenous anastomosis using indocyanine green lymphography (right) and patent blue (left) Q1 What does the lymphatic system do? The lymphatic system is vital to ensure a healthy body. It is responsible for circulating protein-rich lymph fluid though the body. During this process, it collects bacteria, viruses and waste. The fluid gets carried through the lymph vessels to the lymph nodes where the waste is filtered out by infection-fighting cells. The lymphatic system is part of the body's immune system and a crucial aspect of a person's health. Q2 What are the causes of lymphedema? Lymphedema occurs when your lymphatic system is unable to properly drain lymph fluid. While primary lymphedema occurs on its own, secondary lymphedema, which is more common, is caused by a disease or condition. Secondary lymphedema is usually seen when the lymph nodes are removed, oftentimes as part of a cancer treatment. Lymphedema can also be caused by damage to the lymph nodes, from radiation treatment or infection. Should there be a blockage in the lymphatic system, the lymph fluid will not drain well. This leads to fluid buildup and swelling, which generally occurs in the arms and legs. Q3 How can LVA surgery improve lymphedema? LVA surgical approaches, like Dr. Cheng's advanced LVA technique, are effective in reducing or eliminating lymphedema swelling and discomfort. The LVA method directly connects the lymphatic vessels in the affected area to nearby veins. This allows the built-up lymph fluid to drain, which improves the fluid circulation in the body. Typically, LVA is an outpatient procedure, with most patients returning home the same day as the surgery. 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

安德森整形外科診所 Apr 24 Lymphedema The 10th World Symposium for Lymphedema Surgery (WSLS) was successfully concluded The 10th World Lymphedema Symposium was held at Taipei Garden Hotel on April 22-24. The Anderson team, led by Dean Zheng Minghui, spent... 0 0 comments 0 Post not marked as liked 安德森整形外科診所 Apr 30, 2022 Lymphedema Congratulation! The Spanish version of Lymphedema Surgery textbook has been published It is my privilege to announce the Spanish version of our Lymphedema Surgery textbook has been published. I would like to give special... 0 0 comments 0 Post not marked as liked 安德森整形外科診所 Aug 12, 2020 Presentations Dr.Cheng gave A Virtual Visiting Professor Lecture at The University of California, Los Angeles (UCLA) I have appreciated the opportunity to give a virtual visiting professor lecture for UCLA today. It brought back memories of the training... 0 0 comments 0 Post not marked as liked 安德森整形外科診所 Aug 2, 2020 Presentations Dr.Cheng Presented at The 2020 Virtual Duke Flap Course Feel so privileged to be part of the renowned training program with many amazing and talented surgical experts at the 2020 Virtual Duke... 0 0 comments 0 Post not marked as liked 安德森整形外科診所 Jan 12, 2020 Presentations Dr. Cheng Presented at 2020 American Society of Reconstructive Microsurgery (ASRM) Annual Meeting Very happy to have managed to attend the 2020 American Society of Reconstructive Microsurgery (ASRM) Annual Meeting at Marriott Harbor... 0 0 comments 0 Post not marked as liked 安德森整形外科診所 Dec 19, 2019 Congratulation! Papers Published in the Journal Surgical Oncology I want to express my sincere appreciation to the Editor-in-Chief Dr. Stephen Sener of Journal Surgical Oncology, and the co-guest editors... 0 0 comments 0 Post not marked as liked 安德森整形外科診所 Nov 15, 2019 Congratulation! Two Papers Published in Plastic Reconstructive Surgery I feel so happy and humbled to share the great news that two research papers were recently published in the October Issue at Plastic... 0 0 comments 0 Post not marked as liked 安德森整形外科診所 Oct 16, 2019 Raises Breast Reconstruction Awareness in October It was a great pleasure and honor to share my journey as a surgeon of breast constructions at the grand round of our Department at CGMH... 1 0 comments 0 Post not marked as liked

除斑淨膚療程 Spot removal and skin clearing treatment 想要「修修臉」，哪種效果最好!? 皮秒雷射+防曬肌密評比 去除斑點、痘疤、胎記、刺青 告別你的小花臉~~找回淨白無瑕的少女感美光肌 不用遮瑕~不必修圖~不怕素顏見人~ 享受輕透裸妝感 ​ 皮膚的黑色素細胞組織受到環境、紫外線及內分泌等影響，就會讓膚色變黑，產生各種不同的斑點。各種斑點形成的原因不同，在皮膚呈現的深淺度也不同，醫師會根據病灶成因選擇適合的雷射機種來治療。 常見形成斑點的原因 1.紫外線曝曬，皮膚超級虐 太陽光的照射是造成斑點的頭號殺手，當肌膚受到紫外線長時間的照射時，就會啟動黑素細胞活性，進而產生黑色素(Melanin)保護肌膚。健康的肌膚狀況能隨著新陳代謝而淡化，但是當黑色素的生成平衡遭到破壞，或肌膚更新速度異常，導致黑色素過度製造及分布不均時，就會留下斑點或暗沉。 ​ 2.女性賀爾蒙黃體期，特別容易長斑 女性都有經期週期，每月排卵期到生理期來的這一段時間也稱之為黃體期（又稱分泌期），這時候身體會分泌大量的黃體素(Estrogen)，黃體素主要由下丘腦和腦垂體所控制，下丘腦和腦垂體除了分泌黃體素之外，也會伴隨分泌雌激素，雌激素是一種製造黑色素的賀爾蒙，因此當女性處於黃體期時，體內會分泌大量的黑色素，因此防曬就變得更為重要，一旦忽略，會比平時更容易黑色素沉澱形成斑點；懷孕的婦女受到賀爾蒙的影響也容易長斑，尤其在乳暈、腋下、鼠蹊等處，特別容易發生黑色素沉澱。此外，口服避孕丸及停經婦女，因為體內賀爾蒙發生變化，也容易造成黑斑或黑色素在皮膚生成。 ​ 3.皮膚受傷後的色素沉澱 當肌膚受到傷害處於發炎的狀態，此時體內會分泌大量的免疫激素來啟動防禦機制，許多研究已證實免疫激素如白介素-1(IL-1)、白介素-6(IL-6)及腫瘤壞死因子(TNF-α)等，都會刺激黑色素的活性，產生過量的黑色素就稱為發炎後色素沉澱Post Inflammatory Hyperpigmentation (PIH) ，當肌膚受傷或發炎，這時候此區域就會出現斑點，外觀多為棕色、褐色或深褐色，一旦忽略防曬、重複發炎或不治療，可能會永久存在且惡化。常見的PIH症狀如：蚊蟲咬傷造成「紅豆冰」、痘痘發炎擠壓造成痘疤、皮膚癬菌或病毒性發炎、接觸性皮炎引起的色素沉澱。 我的膚色比較暗沈，可以如何改善呢？ 脈衝光(IPL)或彩衝光是全方位的高能量光能照射治療法，它可以治療皮膚暗沈、改善膚色不均、淡化斑點、減弱細紋、縮小毛孔，使皮膚更緊實細緻，療程相對溫和，獲得許多女性的喜愛。 另一個選擇是皮秒雷射(Pico way)，主要是透過不同波長的雷射能量，改善像是黑色素沉澱、膚色不均、痘疤或深淺層斑點等問題。治療無開放性傷口，可快速修復。 我有雀斑，在兩邊顴骨應該如何處理？ 雀斑常見在眼睛下方、兩側顴骨處，較常發生在年輕女性，可以使用銣雅鉻或皮秒雷射治療，它可以震碎色素斑點，而黑色素代謝也較快。 長期曬太陽造成的曬斑，可以徹底清除嗎? 曬斑一般與陽光的照射及紫外線有關，常發生在臉部或手臂上。可以使用脈衝光、銣雅鉻或皮秒雷射治療。雷射後建議要做好防曬，包含物理性及化學性防曬，以避免反黑。 隨著年紀增長，臉部開始出現茶褐色老人斑，會越老越嚴重嗎? 老人斑又稱脂漏性角化症，是型態較多樣化的皮膚症狀，有深淺、平凸不同的呈現，常發生在中年時期，會發生在臉部或手上，可以使用鉺雅鉻雷射治療，或二氧化碳雷射處理，通常需要1~2次的治療，約一週雷射傷口就可復原。若是有單一顆或較大體積的老人斑，建議手術切除，專科醫師若懷疑老人斑合併惡性變化時，會建議使用手術切除並送病理化驗。 臉上長出大片肝斑，該怎麼辦? 肝斑好發於年輕、懷孕後女性，因為內分泌、荷爾蒙或壓力等問題，常見於額頭、顴骨、臉頰兩側等位置，為黃褐、暗褐色的大區塊片狀斑，邊界常不明顯、形狀不規則，呈對稱分佈。雷射可以用來治療很多色素斑點疾病，但對於肝斑的治療效果有限，在雷射部分可以使用脈衝光或皮秒雷射來淡化斑點，但雷射後容易反黑，需要小心防曬。目前的肝斑治療都只能控制，並無法完全根除肝斑。最重要的是要防曬以及維持健康的飲食作息。 臉上有「紅色血管瘤」好困擾，能根治嗎? 血管瘤外觀看起來是紅色的腫塊，主要是因為血管內皮細胞異常增殖以及血管結構異常所產生，可以使用染料雷射治療，有冷卻系統配合比較不痛，此方法也可以用來治療臉上微血管擴張造成的血管絲及改善黑眼圈，是目前血管雷射治療的最佳選擇。 雷射術後「不反黑」的保養秘訣 1.溫和清潔 雷射手術後角質會變得較敏感，對於空氣中的髒污及塗擦防曬產品，還是需要確實的清潔。但因為雷射手術後有可能會有一些微創傷口，建議選擇敏感肌膚使用的卸妝水和不含皂鹼的洗面乳，溫和的清潔肌膚。 ​ 2.鎮定舒緩 可以使用許多醫美品牌所推出的「礦泉噴霧」當作化妝水使用，因為活泉水中有含豐富的礦物質，可以讓肌膚退紅且鎮定舒緩，肌膚感到乾燥時就可以隨時拿起來使用，相當方便 ​ 3.保濕修護-精華液 雷射手術後的保濕、修護相當重要，選擇含有保濕修護功能的精華液，可以有效幫助肌膚修護再生，使肌膚復原得更加快速。 ​ 4.長效鎖水保 濕 使用保養品前可以先敷生物型保濕面膜，能使肌膚加快吸收保養品。再使用乳液或乳霜這類保濕成分較高的產品，不只保濕還可以鎖水，把所需要的營養鎖在肌膚裡。 ​ 5.防曬一定要做好 此段時間的肌膚較敏感，受紫外線刺激可能會產生大量的黑色素，造成手術後的所謂「反黑」問題。因此防曬相當的重要，依據肌膚狀況使用不同的方式做防曬，如使用物理性防曬或防曬產品，也請不要讓肌膚直曬太陽。 ​ 雷射術後避免使用的保養品 1.抗痘效果的保養品 2.各種酸類保養品，例如：杏仁酸、果酸、水楊酸等成分 3.有煥膚功能的保養品 4.美白成分的保養品 5.含酒精成分的保養品

Cheng Lymphedema Grading Systems Say Goodbye to Compression Garments after Dr. Cheng's Lymphedema Microsurgery Lymphedema Grading Systems Using physical exam findings, history of disease and imaging modalities, several classification schemes have been proposed to stage lymphedema. Perhaps the most widely used is the International Society of Lymphology staging system. But this staging system is based only the clinical symptoms, but no objective measurement or imaging assessment. As our understanding of lymphedema has evolved and technologies improved, other staging systems based on clinical presentation, circumferential measurements, objective measurements, lymphatic imaging or a combination thereof have been proposed. Effective and precise treatment A system adopted by the world At our center, we use the Cheng Lymphedema Grading system based on symptom severity, circumferential difference, and lymphoscintigraphy imaging to determine appropriate treatment, which was published on the Annals of Surgical Oncology, a renowned journal: A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. (Patel KM, Lin CY, Cheng MH.) and 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. Cheng Lymphedema Grading Upper Extremity 資料來源： 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. Lower Extremity 資料來源： 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. Novel Taiwan Lymphoscintigraphy Staging System Dr. Cheng is the author of the Cheng Lymphedema Grading System with integration of Taiwan Lymphoscintigraphy Staging which was published in Annals of Surgery (the top Surgery Journal) in July 2018. The Cheng Lymphedema Grading System with integration of Taiwan Lymphoscintigraphy Staging, a comprehensive objective assessment tool that analyzes lymphedema symptoms with quantitative measurements and advanced imaging technology, can effectively help physicians evaluate the severity of lymphatic obstructions, determine the accurate diagnosis, select the most appropriate procedures to treat lymphedema, and ultimately ensure the favorable functional outcome and finest quality of life for lymphedema patients. Taiwan Lymphoscintigraphy Staging Data source: Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC. Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema. Ann Surg. 2018 Sep;268(3):513-525 Data source: Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC. Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng LymphedemaGrading for Unilateral Extremity Lymphedema. Ann Surg. 2018 Sep;268(3):513-525 Partial obstruction Total obstruction Recommended reading journal A Prospective Evaluation of Lymphedema-Specific Quality-of-Life Outcomes Following Vascularized Lymph Node Transfer. Patel KM, Lin CY, Cheng MH. Ann Surg Oncol. 2015 Jul;22(7):2424-30 https://www.ncbi.nlm.nih.gov/pubmed/25515196 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. https://www.ncbi.nlm.nih.gov/pubmed/30004927