Microsurgical Techniques for Lymphedema Treatment: Derivative Lymphatic‐Venous Microsurgery

Abstract

We analyzed clinicopathologic and imaging features of chronic peripheral lymphedema to identify imaging findings indicative of its exact etiopathogenesis and to establish the optimal treatment strategy. One of the main problems of microsurgery for lymphedema is the discrepancy between the excellent technical possibilities and the subsequently insufficient reduction of the lymphedematous tissue fibrosis and sclerosis. Appropriate treatment based on pathologic studies and surgical outcome have not been adequately documented. Over the past 25 years, 676 patients with peripheral lymphedema have been treated with microsurgical lymphatic-venous anastomoses. Of these patients, 447 (66%) were available for long-term follow-up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Objectively, volume changes showed a significant improvement in 561 patients (83%), with an average reduction of 67% of the excess volume. Of the 447 patients followed, 380 (85%) have been able to discontinue the use of conservative measures, with an average follow-up of more than 7 years and average reduction in excess volume of 69%. There was an 87% reduction in the incidence of cellulitis after microsurgery. Microsurgical lymphatic-venous anastomoses have a place in the treatment of peripheral lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with operations performed early, during the first stages of lymphedema.

Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema

“…5,8,9,13,14,17,19,[22][23][24] The findings in our patients confirmed these authors, but the condition and level of the remaining lymphatics is very difficult to estimate preoperatively with clinical or scintigraphic findings, and the timing of the occlusion and degeneration of the smooth muscle cells at the walls of lymphatics may not directly correspond to the duration of the edema 10 ; the stage of the disease seems to be more decisive. An intraoperative observation worth to mention here is, segmental contraction of the lymphangions, recognized clearly in four of our cases (three stage II and one stage III), may be a unique sign for a good outcome after lymphaticovenular anastomosis.…”

“…Warren et al 11 criticized the results of Campisi and Boccardo 22 for they did not present the preoperative excess arm and leg volumes and whether compression garments were used. They, subsequently, argued that it was not possible to interpret the direct benefit from the surgical procedure above the improvement from compression therapy in other series where postoperative compression was used.…”

Growth Factor Therapy and Autologous Lymph Node Transfer in Lymphedema

“…The conventional treatment for chronic lymphedema aims at alleviating the symptoms and is based mainly on physiotherapy and/or controlled compression therapy, whereas current surgical treatment options are limited. [3][4][5] This is due chiefly to difficulties in identifying and preserving the lymphatic vessels even by modern microsurgical methods. Recently, microvascular lymph node transfer into axillas of patients who had undergone axillary lymph node dissection in response to disseminated breast cancer was shown to improve lymphatic drainage in some patients.…”

Surgical Prevention of Arm Lymphedema in Breast Cancer Treatment

“…Normal lymphoscintigraphy pattern corresponded to TI less than 10. An impaired LS pattern in our study had a mean TI of 16 (range [12][13][14][15][16][17][18][19]. Moreover, pre-operatively LS had a significant predictive value (TI) in terms of risk of lymphedema appearance.…”