Microlymphaticovenous and resectional surgery in obstructive lymphedema

Abstract

Abstract In many cases of moderate obstructive lymphedema, there are sufficient lymphatics still remaining at a proximal level in the limb to anastomose them under the operating microscope to small veins, thus bypassing a proximal axillary or inguinal obstruction. Most of the cases reported in this article followed surgical and irradiation treatment of the breast for malignancy, and the majority occurred in the upper limb. The microtechnique of microlymphaticovenous anastomoses is described and a series of 136 patients is analyzed. Preoperative conservative therapy with elevation, stockingette, and pumping are used, but now only for a few days. Lymphangiograms have been found harmful, and this investigation has been discontinued. The usual sites of anastomoses of lymphatics are the medial aspect of the thigh or upper arm. Increasingly, microsurgery is being combined with a segmentai reduction on the outer aspect of the upper arm or thigh. Microlymphaticovenous surgery was performed in 40 patients, and 35 of these were available for follow‐up studies. The patients were assessed post‐operatively on objective and subjective grounds. Two‐thirds of the patients showed a significant reduction of the excess limb volume, and a higher percentage of patients showed encouraging subjective signs of improvement. Twenty‐one patients were not suitable for microlymphaticovenous surgery, and a one‐stage surgical reduction was carried out with a very useful result, although not as natural as that following microlymphaticovenous surgery. Cellulitis was significantly reduced in both groups following this surgery. The ultimate reduction of excess volume was related to age, primary diagnosis, and primary mode of therapy. An adequate result was not obtained in patients in whom only 1 anastomosis was performed, and such procedures are no longer carried out. Regular follow‐up has been performed with volumetric and circumferential measurements, and there have been no major complications of microlymphaticovenous surgery .