Role of microsurgery in the management of lymphoedema

BACKGROUND: Microsurgical techniques in the treatment of peripheral lymphoedema proved to be very promising, the authors' clinical experience with derivative and reconstructive lymphatic microsurgical operations was analysed. METHODS: From 1973 to 1997, 843 patients were studied and treated by microsurgical methods, with average follow-up of over 5 years. Microsurgical techniques mostly consisted of derivative lymphatic-venous or lymphatic-capsule-venous anastomoses and reconstructive autologous vein interpositioned grafts (lymphatic-venous-lymphatic-plasty). Ninety percent of patients were operated on at the II-III stage, 3% at the I and 7% at the IV-V stage. Limb volumes were measured using the water displacement technique and lymphoscintigraphy was used to accurately assess the structural and functional status of the lymphatic drainage before and after variable distances of time after microsurgery. More recently, also lymphangio-MR was used to accurately evaluate changes in the lymphoedematous extremity before and after treatment. RESULTS: Postoperatively, all the patients had a reduction of oedema variable above all according to the stage of the pathology at the time of microsurgical operation. Short and long-term results were positive, as concerns both volumetric oedema reduction and arm function, besides the regression of annual incidence of acute lymphangites. The efficacy of microsurgical lymphatic operations has been verified, moreover, by lymphoscintigraphy. CONCLUSIONS: Microsurgical techniques permit, today, the solution of complex clinical patterns not only of secondary but also of primary, unilateral and bilateral, lymphoedemas, at different stages, with better results the more precocious the microsurgical treatment is, with stabilization of the result also at long distance of time from operation.