Lymphedema and microsurgery

Abstract

Lymphedema is often diagnosed by its characteristic clinical presentation. In some cases, however, instrumental investigations are necessary to establish the diagnosis, particularly in early stages of the disease. One of the primary problems for microsurgery in treating lymphedema consists of the discrepancy between the excellent technical possibilities and the insufficient results in reduction of lymphedematous tissue fibrosis and sclerosis. Long-term results indicate that microsurgical operations have a valuable place in the treatment of obstructive lymphedema (primary or secondary) and should be the treatment of choice in these patients. Improved results can be expected with earlier microsurgical operations because patients referred earlier usually have less lymphatic disruption and fibrotic tissue. Advanced diagnostic methods and improvements in operation techniques have modified indications for surgical therapy of lymphedema. This article systematically reviews the published literature on the microsurgical treatment of lymphedema to the present.

Interstitial fluid flow induces myofibroblast differentiation and collagen alignment in vitro

“…In addition, in many tissues fibrosis is typically preceded by chronic inflammation, which provides a source of inflammatory cell-derived cytokines such as TGF-␤ 1 that are crucial mediators of fibrogenesis. However, fibrosis can also follow non-inflammatory events such as swelling in lymphedema (Campisi and Boccardo, 2002) and in idiopathic pulmonary fibrosis (Pardo and Selman, 2002); the mechanisms of myofibroblast differentiation and subsequent progression to fibrosis are still not clear in such pathologies, and the role of interstitial flow that typically accompanies such processes has not previously been addressed.…”

Lymphedema: From diagnosis to treatment

“…Fluorescence is used to help identify the lymphatic system and an operating microscope is used to assist in microsurgery (41). Single or multiple LVA's have been reported by different authors using differing surgical sites (39,(42)(43)(44). Supermicrosurgery (anastomosis less than 0.8 mm vessels) is used in this technique, in which lymphatic vessels and adjacent venules are anastomosed, mostly in an end-to-end fashion (39,43) (Figure 5).…”

Strategic Incision Placement to Facilitate Successful Supermicrosurgical Lymphaticovenular Anastomoses

“…Following IRB approval, the patients at the University of Iowa Hospitals and Clinics who underwent LVA for treatment of secondary lymphedema between July 2015 and December 2015 were recruited for study [9,10]. Disease severity was staged clinically using Campisi criteria (Table 1) and radiographically using indocyanine green (ICG) lymphography staging criteria previously described by Yamamoto et al [11].…”