Secondary lymphedema is a chronic progressive disorder of lymphatic system caused by tumour surgery and/or radiotherapy. With the development of microsurgical techniques, the surgical procedures currently applied in the treatment of lymphedema mainly focuses on lymphatic-lymphatic anastomosis (LLA), lymphatic venous anastomosis (LVA), vascularised lymph node transfer (VLNT) and vascularized lymph vessel transfer (VLVT). The goal of microsurgical treatment of lymphedema is to reconstruct the physiological lymphatic circulation. Both of LLA and LVA require higher microsurgical skills. VLNT has a risk of iatrogenic lymphedema in the donor site and has impacts on the appearance of the recipient site, while the VLVT can better avoid the shortcomings of the treatment options mentioned above with a definite clinical effect. The donor site can be directly anastomosed. This article provides detailed reviews and updated concepts in treatment of lymphedema with VLVT in terms of development, therapeutic mechanism, clinical efficacy, surgical techniques and skills of the vascularised lymphatic flap.