Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3783_Библиотеки_им_академика_М_И_Перельмана

A COE is a designation awarded by LE&RN to institu­tions that offer comprehensive care for lymphedema [5]. For centers that do not offer comprehensive care but do have ser­vices for patients with lymphedema, other designations can be given, including Networks of Excellence, Referral Networks of Excellence, LD Surgery COE, and LD Conservative Care COE (Fig. 28.1) [4]. These address the overall shortfall of qualied institutions for lymphedema care because some institutions offer high-quality services for the care of patients with LD, but not comprehensive care. There are 13 major categories by which LE&RN uses to evaluate applicants, each with multiple criteria, most of which must be met to achieve the COE designation. The cat­egories used to evaluate potential centers include diagnosis, imaging, nonoperative management, assessment tools, inter­ventional therapies, surgical treatments, genetics evaluation, interdisciplinary consulting ability, research, accountability, collegiality, administration, and community [4]. Once a cen­ter has applied for and been awarded a designation, their information appears on the LE&RN website, which acts as a centralized, pre-vetted, and reputable source for patients.

Patients referred to the pediatrics arm of the Boston Lymphatic Center tend to have different presentations and medical needs than the adult program. Between 2009 and 2019, most patients referred to the center were females with congenital lymphedema [9]. Under a quarter of referred patients had secondary lymphedema, and 16% had obesity­induced lymphedema (OIL) [9]. The remainder were found to have diagnoses other than lymphedema upon evaluation, underscoring the need for greater understanding of lymph­edema by the general medical community. Upon referral, lymphedema diagnosis is similarly conrmed by lymphatic medicine as in the adult program, and individuals receive counseling and education about their condition, including ways to prevent progression and complications. All patients are initially managed by the lymphatic treatment clinic with nonoperative medical therapies such as compression gar­ments, placing focus on volume maintenance and infection prevention. In contrast to the adult pipeline, only 6% of patients in the pediatric program were treated with surgical intervention [9]. Those that were treated surgically under­went debulking surgery with suction-assisted lipectomy. Patients with OIL were referred to bariatric surgical centers, as OIL does not respond to typical lymphedema treatments, and lymphatic function cannot be improved without signi­cant weight loss. Regardless of lymphedema etiology, every patient that was referred had a tailored approach to treatment that was made possible by a collaborative effort of the multi­disciplinary team.

At the Boston Lymphatic Center, we are proud to offer com­prehensive care to patients both with and without lymph­edema and to have earned the LE&RN COE designation. We hope by sharing our experience, including the specics of our multidisciplinary approach for both children and adults, other centers may have insight into how to offer comprehen­sive care for patients with lymphatic disorders and how to secure a COE designation.