Ask Dr. Jay Granzow

Areas of Expertise:

  • Lymphedema Surgery
  • Integrated Lymphedema Treatment System
  • VLNT (Vascularized Lymph Node Transfer)
  • LVA (Lymphaticovenous anastomosis)
  • SAPL (Suction Assisted Protein Lipectomy)
  • Lipedema Surgery
  • Lipolymphedema Surgery

Bio:

Dr. Jay Granzow is an internationally respected lymphedema surgeon. He serves as Professor of Surgery in the Division of Plastic Surgery at the UCLA David Geffen School of Medicine, and Assistant Chief of Plastic Surgery at Harbor-UCLA Medical Center. He is Board Certified both in Plastic Surgery and Head and Neck Surgery.

A pioneer in lymphedema surgery, Dr. Granzow successfully integrated lymphedema therapy with three types of lymphedema surgery including vascularized lymph node transfer (VLNT), lymphaticovenous anastomosis (LVA) and suction assisted protein lipectomy (SAPL). He has published major scientific articles on lymphedema surgery in leading medical journals. Dr. Granzow is a frequent lecturer at U.S. and international conferences, educating patients, therapists and physicians on the latest advances in lymphedema surgery. Dr. Granzow provides lymphedema treatment for patients in his private medical practice located in the Los Angeles area.


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  1. lymphedema in children
    Question (ahmed, ):
    • Hi DR Granzow As vascular surgeon ,I met in my clinic children below 5 years and complaining from different forms of primary lymphedema ( localized to the feet or leg ,sometimes involve whole limb,).my questions are : 1- what is the best investigation tool ( e.g.NIRFLI,MRI ...)? 2-do you prefer certain age for intervention i.e. postpone surgery untill growing up? 3- what are kind of surgery do these children need( e.g.SAPL,VLNT)&are these surgeries different from those in Adult? Thanks in advance A.SAWABY

    Answer:
    • Oct 2018

      The patients that I treat are primarily adult patients but I have come across children and teenagers who have primary lymphedema.  I would consider MRI of the affected extremity and adjacent torso to better characterize the limb and also rule out proximal pathology that may be contributing to the swelling. 

      An indocyanine green imaging study in both the affected limb and the unaffected side would also be very helpful.  I would recommend having this study also performed with the child under anesthesia, as the injections can be difficult to tolerate.

  2. VLNT & Compression Pump
    Question (Dana, ):
    • I was recently diagnosed with RT leg lymphedema after a single SLNB in my groin. I am learning to manage with daily compression use and the flexitouch, but am only 34 and expect to need surgical and/or other therapeutic treatment in the future due to the progressive nature of the condition and duration. As many patients do I seek tips, tricks, and community through other lymphedema patients on social media. A patient recently posted that she is having VLNT and surgeons do not want you to use the compression pump before or after. Is that accurate? If so, immediately before surgery or ever? Can you explain why? Thank you.

    Answer:
    • Oct 2018

      The compression pump can be effective for some patients in moving lymphedema fluid and helping manage the fluid part of the lymphedema volume excess.  Other modalities that also move fluid are manual lymphatic drainage (MLD), compression garments, and microsurgery such as vascularized lymph node transfer (VLNT) or lymphaticovenous anastomosis (LVA).

      For my patients, I have no issue with compression pump use before surgery.  For VLNT surgery, I typically allow my patients to use their compression pump again 6 weeks or so after surgery.

      Please keep in mind that treatments I mentioned above (MLD, VLNT and LVA surgeries) are not be effective in reducing the permanent solid portion of lymphedema swelling.  Such solid swelling has also been described as “non-pitting”.  This solid excess is best treated with SAPL lymphedema surgery, prior to repairing the defect in your lymphatic system using microsurgeries such as VLNT or LVA surgeries.

  3. SAPL TECHNIQUE
    Question (ahmed, ):
    • DEAR Dr.Jay I am interested in lymphedema surgery. If you allow me to ask you about SAPL technique : 1_Which cannula type you prefer for liposuction ? 2_What is your solution for humping of forefoot (long lasting CDT or liposuction)? 3_what is the max. amount of liposuction per limb? 4_in st.II lymphedema,when you decide to liposuc? Thanks in advance A.Sawaby

    Answer:
    • Sep 2018

      Thank you for the interest in SAPL surgery.  I believe a bit of background will give more insight into the answers. 

      Lymphedema swelling comes in 2 forms – fluid swelling and solid swelling.  Fluid swelling occurs first, and is caused by accumulation of the inflammatory lymph fluid.  This can be treated with modalities that move fluid and include conservative treatments such as compression garments, manual lymphatic drainage and compression pumps.  This fluid in most people tends to collect more in the feet, ankles and lower legs due to the effects of gravity.  Swelling in the foot tends to be fluid, and typically is best addressed in this way.  Microsurgery procedures such as LVA or VLNT also are effective in moving fluid.

      Over time, the inflammation caused by this fluid leads to damage of the surrounding structures and permanent deposits of solids.  These can be quite thick, and cannot be removed with conservative treatments or LVA/VLNT surgery. 

      I find that an integrated approach to lymphedema treatment consistently yields the best results.  Therefore I prefer initially to use proper lymphedema therapy to reduce the fluid volume excess first, and then use SAPL surgery to remove the remaining solids to allow the limb to approximate its normal size.  My experience is that few patients have sufficient excess solid present in the foot and ankle to require SAPL surgery in these areas.

      SAPL surgery can be used for solids that have been present for both short or very long times.  I have successfully treated patients whose lymphedema solids were present for almost 50 years.  To remove the solids, a blunt, custom-made cannula that is much larger and longer than average is used.  While the maximum amount of solids that can be removed varies from person to person, in almost all cases I have been able to treat an entire leg in one surgery. 

      It is important to note that SAPL surgery is very different from cosmetic liposuction. This is due to significant differences in the technique used, such as the use of a tourniquet during SAPL, which can greatly increase safety and also the amounts of volume that can be removed when properly applied.

  4. diagnosis
    Question (Sheila, ):
    • How do I go about finding a doctor to diagnose and support me in my struggle with lipedema or lymphedema? My primary care said she read some articles and thought it was Lymphedema. She referred me to two different vascular surgeons, both found insufficient veins and seemed gleefully happy that I would qualify for surgery...however neither led me to believe this would be anything more than short-term relief and neither made me feel this would result in significant improvement. Instead I went to an OT who has helped me a great deal. Her therapy combined with compression stockings that were made specifically for me has helped somewhat. Looking long-term, I would love to find a knowledgeable physician to guide me and support me in making decisions to support my journey. What type of specialist would this be? Are there any in New England? Thank you,

    Answer:
    • Sep 2018

      This is a question often asked by patients with lipedema or lymphedema.  Unfortunately, many health providers are not familiar with these conditions to provide adequate guidance to patients.  In fact, most physicians receive little to no teaching about lymphedema during their entire 4-year medical education.  Patients often report that they feel they have more knowledge than their primary care physicians about their condition. 

      We find that patients who are successful in managing their conditions have a team of knowledgeable medical professionals who care for them.  For instance, this team could be comprised of a primary care physician who is open-minded and want to learn about lymphedema or lipedema, a certified lymphedema therapist (CLT) who provides ongoing therapy for the patient, and perhaps a surgeon who has expertise in lymphedema or lipedema.