Microsurgical treatment of peripheral lymphedema: An overview upon 25 years clinical experience

The Authors report an overview upon the modern surgical treatment of peripheral lymphedema. In the past, only the most severe and advanced cases of elephantiasis were surgically treated, mainly in order to reduce the volume of lymphedematous limbs, but being highly demolishing and invasive operations, they could not be recommended in less advanced or initial stages and even less so in children. Lymphatic Microsurgical operations allowed to find long-lasting remedies to peripheral lymphedemas from the aetiological and pathogenetical points of view. The aim of this treatment is to drain the lymph either towards 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). The selection of candidate patients for Lymphatic Microsurgery is based on an adequate diagnostic investigation, which includes above all Lymphoscintigraphy, conventional oil contrast Lymphangiography (especially in lymphatic and chylous reflux pathologies), Doppler venous flowmetry and manometry and, if it is necessary (angiodysplasias), an accurate study also of the artery circulation. The clinical outcome of Lymphatic Microsurgery, assessed particularly by water volumetry and lymphangioscintigraphy, performed at variable distance of time from operations till over 5 years after surgery, show a significant reduction of edema volume and improvement of lymph flow in all patients. Finally, the more precocious the microsurgical treatment is the better are the results.