The 50 most-cited publications in lymphatic surgery: A bibliometric analysis

Background Lymphatic surgery has evolved from palliative debulking procedures to physiologic reconstruction using microsurgical and supermicrosurgical techniques. Despite this progress, the publications that have most influenced this evolution have not been systematically examined. This study aimed to analyze the 50 most-cited publications in lymphatic surgery, assessing their bibliometric characteristics, study designs, levels of evidence, and thematic contributions to lymphedema surgical management. Methods The Web of Science Core Collection was searched for articles on surgical treatment of lymphedema from inception to November 7, 2025. The 50 most-cited articles were identified and analyzed for citation count, citation density (citations per year), authorship, geographic origin, journal distribution, and keyword frequency. Studies were categorized by design and evaluated according to the Oxford Centre for Evidence-Based Medicine levels of evidence. Concise summaries were generated to facilitate access to key findings. Results Published between 2004 and 2023, the top 50 articles accumulated 4612 citations (mean 92.2, median 75.5). Citation density ranged from 3.9 to 32.5 citations per year. Plastic and Reconstructive Surgery was the most represented journal ( n = 14). Asian institutions predominated, with Japan ( n = 16) and Taiwan ( n = 11) accounting for 54% of publications. Case series were the most common study design ( n = 24). Most studies provided Level 4 or 5 evidence (74%), although two Level 2 randomized controlled trials were identified. Keyword analysis identified supermicrosurgery, lymphaticovenular anastomosis, and indocyanine green lymphography as the most recurring technical concepts. Conclusions This bibliometric analysis highlights seminal publications underlying the development of supermicrosurgical techniques such as lymphaticovenous anastomosis and vascularized lymph node transfer. The results demonstrate a strong Eastern contribution to innovation. While observational studies predominate, the near-total absence of Level 1 evidence and the presence of only two Level 2 trials underscore the need for well-designed prospective comparative studies to establish standardized treatment algorithms. Level of evidence: IV