Our clinical observations in 64 patients affected by chronic obstructive lymphedema (either arm or leg) undergoing interposition autologous lymphatic-venous-lymphatic (LVL) anastomoses are reported. This microsurgical technique is an alternative to other lymphatic shunting methods, especially when venous dysfunction coexists in the same limb and, therefore, when direct lymphatic-venous anastomosis is accordingly inadequate. Preoperative diagnostic evaluation (including lymphatic and venous isotopic scintigraphy, Doppler venous flowmetrics, and pressure manometry) plays an essential role in assessing the conditions of both the lymphatic and venous systems and in establishing which microsurgical procedure, if any, is indicated. Our microsurgical technique consists of inserting suitably large and lengthy autologous venous grafts between lymphatic collectors above and below the site of obstruction to lymph flow. The data show that, using this technique, both limb function and edema improved, and in all patients followed up for over 5 years edema regression was permanent.
Microsurgical derivative procedures to treat chronic lymphedemas of the limbs are reported here. Techniques used consisted of lymphatic capsule-venous anastomoses (in pediatric patients) and end-to-side lymphatic-venous anastomoses. Results after more than 5 years showed improvement in about 70% of the cases. The importance of an accurate preoperative diagnostic evaluation and the precise indications for these microsurgical procedures are discussed. Some personal modifications of derivative microsurgical techniques and their advantages are also pointed out.
We report clinical observations in 67 patients with chronic lymphedema undergoing hyperthermia. Our technique of hyperthermia is an alternative to microwave therapy, particularly where lymphangitis coexists in the same limb. Preoperative diagnostic evaluation including lymphatic and venous isotopic scintigraphy, Doppler venous flow metrics, and pressure manometry play an essential role in delineating the status of both the lymphatic and venous systems and in determining if hyperthermia is indicated. Our method of treatment consists of producing hot and humid ambience inside the chamber where the limb is situated. The data demonstrate the feasibility of our method of hyperthermia in 67 patients with postlymphangitis lymphedema (either arm or leg). Using this technique, improvement was seen in both limb function and edema.
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