Frontiers in lymphatic microsurgery

Abstract

The Authors report an overview on the modern surgical treatment of peripheral lymphoedema. The aim of lymphatic microsurgical operations is to drain the lymph either toward the venous circulation (lympho-venous shunts) or the lymphatic collectors above the obstacle to the lymph flow, with the interposition of lymphatic or venous grafts (lymphatic-venous-lymphatic plasty). Selection of candidate patients for lymphatic microsurgery is based on an adequate diagnostic investigation, which includes above all lymphoscintigraphy, conventional oil contrast lymphangiography, Doppler venous flowmetry and manometry, and, if necessary (angiodysplasias), an accurate study also of the artery circulation. The clinical outcome of lymphatic microsurgery, assessed by water volumetry and lymphangioscintigraphy, performed at variable distance of time from operations till over 5 years after surgery, shows a significant reduction of edema volume and improvement of lymph flow in all patients and that the more precocious the microsurgical treatment the better the results.

Extrapulmonary Soft-Tissue Fibrosis Resulting From Hypofractionated Stereotactic Body Radiotherapy for Pulmonary Nodular Lesions

“…Thus, lymphedema in a location remote from the site of RT is not an uncommon sequela. Physical and manual massage (28) and microsurgical lymphatic venous anastomosis (29,30) have been attempted as treatments for such lymphedema; however, none of these are definitive treatments.…”

Update on Post-mastectomy Lymphedema Management

“…This technique is now largely abandoned secondary to the high rate of thrombosis at the anastomosis site triggered by the reaction between the lymph node pulp and the venous blood . Direct lymphatico‐lymphatic anastomoses have been described using auto‐lymph vessel graphs , but this is usually not the technique of choice, with most groups reporting the use of lymphaticovenous anastomoses (LVA) or use of venous interposition grafts between lymphatics .…”

Vein Graft Interposition in Treating Peripheral Lymphoedemas

“…The lymphatic flow inside the vein graft rapidly tended to reduce due to the fast reduction of lymphoedema volume. For this reason, which led to the significant decrease of limb volume immediately after microsurgical operation, the patient needed to wear stockings for one to five years after microsurgery (according to the stage of the disease before the treatment and the entity of fibrose tissue) to maintain and improve the results over time [4].…”

“…Techniques of reconstructive lymphatic microsurgery for managing peripheral lymphoedemas include interposition of autologous lymphatic-venous-lymphatic (LVL) shunts [4], autologous lymphatic transplantation [1] and free lymphatic or lymph vessel nodal flaps [2]. Among these microsurgical reconstructive methods, interpositional LVL shunt allows a great volume of lymph to be transported because of the large number of lymph collectors which can be anastomosed to the venous graft [5].…”