Lymphedema is the abnormal accumulation of lymph fluid in the tissues. Lymphedema could either be Primary or Secondary. Primary lymphedema is caused by a malformation of the lymph vessel network or lymph nodes and can be evident at birth or appear later in life. Secondary Lymphedema (most common type) results from trauma, surgery, cancer, infection and radiotherapy etc., that caused damage to the various components of the lymphatic system.

Damaged lymph vessels or nodes are unable to drain lymph fluid from the tissue, which leads to lymph fluid accumulation, swelling, chronic pain, inflammation and heaviness in the affected area. Lymphedema management starts with a lymphedema therapist and includes exercise, manual lymphatic drainage massage, various degrees of graded compression garments/bandages and pneumatic compression. This is followed by various surgical options depending on the stage of lymphedema and are divided into physiological, debulking and combined options. Physiological options address the “lymph fluid” buildup and allow for continued drainage of the affected limb.

Debulking procedures address the “fat and fibrous tissue” that develops due to the chronic inflammation from the lymph fluid in the tissues. As lymphedema progresses, these procedures need to be combined to get the best outcome. Indocyanine green (ICG) lymphangiography imaging is used to stage lymphedema, map out the functional lymph vessels and monitor progress after surgery. Dr Moodie has partnered with Erika van der Mescht and the team at Physio-Kinetix to provide comprehensive lymphedema therapy before and after surgery.


Physiological options:

1Lymphaticovenular Anastomosis (LVA)
Lymphaticovenular Anastomosis is a minimally invasive surgical option that joins several functional lymphatic vessels and veins in the affected area to divert the lymph fluid to the venous bloodstream. This means that the blocked lymph network has somewhere to drain into. Lymph diversion to the bloodstream is physiological as our bodies have natural connections between the lymph and bloodstream in specific anatomical areas. The role of LVA is to address the “fluid component” of lymphedema and can be performed in all stages of lymphedema to drain the lymph fluid accumulation.
2Lymph Node Transfer
The transfer of functional lymph nodes from a healthy donor site to a part of the body with a damaged or poorly functioning lymphatic system is known as vascularised lymph node transfer (VLNT). This transplant, like LVA, addresses the “fluid component” of lymphedema. It is ideally indicated when there are no good functional lymphatic vessels for LVA. The transplant improves lymphedema by adding functional nodes to the affected limb to create a new physiologic lymph drainage pathway. The groin, axilla, neck, omentum, and submental area are popular locations for donor lymph nodes. Preoperative and intraoperative imaging should be utilised to identify ideal donor site lymph nodes.

Debulking options:

1Lymphedema liposuction, resection and limb contouring.

(Flying squirrel technique) :

This procedure addresses the "fat and fibrous tissue" component of lymphedema in the affected limb. The first step is aggressive liposuction to remove as much fat as possible circumferentially. In most cases, this leaves the limb with a significant amount of excess flabby skin. The second step is surgical excision of the internal thick fibrous tissue. The third step is excision of the excess flabby skin and precise closure to contour the limb as required. Lymphedema liposuction is only a debulking procedure and does not add any physiological lymph drainage mechanism. It should therefore be followed by a lymph node transfer 6-9 months after the liposuction procedure.


1Is lymphedema surgery painful?
Mild to moderate discomfort should be anticipated after surgery, depending on the type of surgery planned. LVA is the least uncomfortable and liposuction somewhat more.
2How long does lymphatic surgery take to complete?
LVA procedure takes, on average, 4-5 hours.
Vascularised lymph node transfer takes around 6-8 hours.
Flying squirrel liposuction takes around 4-6 hours to complete.
3How long does it take to recover from lymphatic surgery?
Recovery will take between three to six weeks to complete.



Beethoven, 1812



Dr Moodie knew that he wanted to become a surgeon from the onset of his medical school training at the University of Pretoria, finding the opportunity to repair the human body extraordinary.

His logo, which you see on this website, was inspired by a sculpture by Reghardt van der Meulen “Fragmented“.