AdventHealth's Lymphatic Network of Excellence Built on Elevated Standards Across Care Teams

In recognition of its work to advance the diagnosis and treatment of lymphatic diseases, AdventHealth recently earned designation as a “Comprehensive Network of Excellence” from the Lymphatic Education & Research Network (LE&RN). It is the only center in the Southeast, one of nine nationwide and among 15 healthcare organizations globally to achieve this status.

LE&RN is an internationally recognized nonprofit organization founded in 1998 to fight lymphatic diseases, including lymphedema and lipedema, through education, research and advocacy. It established its Centers of Excellence in the Diagnosis and Treatment of Lymphatic Diseases certification program in 2018 to improve access to multidisciplinary clinical care for individuals and families affected by lymphatic diseases.

AdventHealth’s comprehensive lymphedema and lipedema program was established in 2023 under the leadership of plastic surgeon and Medical Director Richard Klein, MD, MPH, CLT-LANA, FACS. To achieve the Comprehensive Network of Excellence designation, the program had to have at least three Certified Lymphedema Therapists (CLTs) within the network and demonstrate proficiency in the following areas: diagnosis, imaging, conservative management, assessment tools, interventional therapies, surgery (with a minimum of 3 surgeons performing lymphatic surgeries within the network), genetics, consultation, research, accountability, collegiality, administration and community involvement.

“The LE&RN designations are really the international gold standard in the field of lymphedema and lipedema, and achieving this certification reflects our multidisciplinary team’s commitment to providing preeminent care,” shares Dr. Klein.

Advancing Care for Lymphatic Diseases

The two most common lymphatic diseases treated at AdventHealth include lymphedema and lipedema. Impacting an estimated 10 million people in the United States, lymphedema is a chronic condition that most often occurs after cancer treatment or surgery (secondary lymphedema). It involves abnormal accumulation of protein-rich interstitial fluid in the tissues due to impaired lymphatic drainage, resulting in persistent swelling usually in the arms or legs. Left untreated, it can lead to reduced mobility and increased risk of skin infections, including cellulitis. Although less common, primary lymphedema can occur due to congenital or hereditary abnormalities.

Lipedema is a chronic, progressive and primarily inherited adipose tissue disorder characterized by abnormal, bilateral and symmetric accumulation of subcutaneous fat, primarily in the lower extremities (hips, thighs, calves) and sometimes the arms, while sparing the feet and hands. Occurring almost exclusively in women, it is often mistaken for lymphedema or obesity, but the fat is resistant to diet and exercise.

Over the past three years, AdventHealth has been building a comprehensive program that encompasses lymphatic medicine, surgery, imaging and therapy to care for patients with both lymphedema and lipedema along with other lymphatic anomalies. Key components include the following:

• Specialized Imaging – When combined with clinical evaluation of swelling, specialized imaging helps to confirm lymphatic dysfunction and rule out other causes. Lymphoscintigraphy (LSG), a form of nuclear medicine imaging, uses radioactive dye to visualize lymphatic flow and structure and to identify blockages. Another tool, near-infrared fluorescence lymphatic imaging (NIRFLI/ICG), involves intradermal injection of indocyanine green (ICG) to visualize superficial lymphatic vessels and functional nodes in high detail. Additionally, magnetic resonance lymphangiography (MRL) and MRI can provide detailed, 3D high-resolution images of tissue structure, subcutaneous thickening and lymphatic vessels, while duplex ultrasound (DS) can help assess tissue characteristics, fluid accumulation and exclude venous causes.
• Surveillance – Developed by one of AdventHealth’s lymphedema therapists, a proactive, evidence-based surveillance program monitors patients at risk of developing lymphedema, especially those who have completed cancer treatment. The goal is to detect, diagnose and treat fluid buildup early, often before symptoms appear. A non-invasive technology called bioimpedance spectroscopy (BIS) aids in this process, sending a low-strength, multi-frequency electrical current through the body to measure body fluid, tissue volume and composition.
• Complete Decongestive Therapy (CDT) – Commonly known as lymphedema therapy, CDT manages swelling from lymphatic system blockage using a combination of gentle massage known as manual lymphatic drainage (MDL) along with compression/bandaging/garments, specific therapeutic exercises and meticulous skin care to help reduce fluid buildup, improve function and prevent complications like infection. AdventHealth currently has 26 certified lymphedema therapists in the Central Florida region who perform this therapy along with providing patient education on self-management.
• Surgical Care – Dr. Klein led the team that performed the first vascularized lymph node transfer (VLNT) for lymphedema in Florida in 2013 and brings this expertise to AdventHealth. VLNT is a specialized microsurgical procedure that involves harvesting healthy lymph nodes, along with their surrounding fat and blood vessels, from another part of the body such as the groin, neck or abdomen, and transplanting them into the affected limb. He also performs lymphovenous bypass, a microsurgery for early-stage (I or II) lymphedema that connects damaged lymphatic vessels directly to small nearby veins, allowing excess fluid to drain back into the bloodstream. AdventHealth plastic surgeon Omar Beidas, MD, FACS, specializes in surgical care for patients with lipedema, including specialized liposuction techniques.

“These microsurgical operations have been able to significantly improve quality of life for our patients,” explains Dr. Klein. “Not only have we been able to improve some of the complications associated with lymphedema like recurrent infections, but many of our surgical patients can also reduce or eliminate their reliance on manual lymphatic drainage and daily compression garments.”

Improving Early Identification and Patient Support

Looking ahead, the AdventHealth lymphedema and lipedema team plans to continue expanding the program both in terms of reach and services provided, which will enable it to apply for higher levels of certification through LE&RN. This growth includes adding more surgeons, therapists, a Symani robotic microsurgical system and a specialized nutrition program along with efforts to increase education and research.

“Too many people in this country initially present with late stages of lymphedema because the disease is not well recognized,” says Dr. Klein. “If we can catch it early, the outcomes are so much better. Our team remains committed to not only expanding and continually improving our services, but educating providers, especially surgeons, throughout our community to better identify patients who could benefit from the specialized care we provide.”

To refer a patient for lymphatic disease diagnosis or care, contact our care team.