• Tzou Chieh-Han John CJ http://orcid.org/0000-0002-3903-801X Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, Vien, Johannes Steinbacher, Manon Czedik-Eysenberg, Silvia Brandstaetter, Stefan Meng, Matthias Schuetz, Lisa Macho, Brigitte Obermayer, Viktor Grablowitz, Christoph Ausch, Ming-Huei Cheng, and Joon Pio Hong.
• Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior, Vienna, Austria.
• J Surg Oncol. 2020 Jan 1; 121 (1): 91-99.

BackgroundLymphedema surgery was not widely known in Austria before the introduction of lymphovenous anastomosis (LVA) and vascularized lymph node transfer (VLNT) in 2014. This study shares the experience and process of establishing and institutionalizing lymphedema surgery service in Austria.MethodsThe purpose of introducing reconstructive lymphedema surgery in Austria was to improve lymphedema patients' quality of life and provide them surgical therapy as an adjuvant treatment to complete decongestive therapy. To initialize reconstructive lymphedema surgery in Austria, LVA and VLNT had to be presented and introduced, in the manner of branding and advertizing a new product. Surgeries were performed with quality control by standardized documentation, pre- and postoperatively.ResultsAligned with branding and marketing, presentations were given externally and internally to share knowledge and experience of lymphedema surgery. Lymphedema surgery service was introduced as a new brand in the medical service in Austria. After several communications with the Austrian Health Insurance Fund and with the final application, LVA and VLNT were listed as novel surgical therapies in its 2020 reimbursement catalog. Since 2014, more than 300 lymphedema patients were consulted, and 102 reconstructive lymphedema surgeries were performed. Circumference reduction of extremities after surgery was between 20% and 43%, postoperatively.ConclusionAcceptance of surgery in lymphedema patients varies among continents, hospitals, and surgeons. Evaluation of the requirement of the surgical setup and insurance conditions for lymphedema surgery is essential to establish lymphedema surgery, providing targeted marketing and branding to spread knowledge of the novel technique and grant patients access to therapeutic treatment of their chronic disease.© 2019 Wiley Periodicals, Inc.

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