Lymphatic Surgery

Microsurgical therapy of lymphedema and surgery of the lymphatic vessels

Lymphatic fluid obstruction in the tissue can be either congenital (primary lymphedema) or develop following cancer surgery and lymphadenectomy (secondary lymphedema). Primary therapy always consists of a complex decongestion by use of lymphatic drainage, compression dressings, and stockings. If these measures are unsuccessful, surgical therapy can help in specific circumstances.

An available option is the establishment of microsurgical connections between the severed lymphatic ducts and small lymphatic vessels or veins (lympho-venous or lympho-lymphatic anastomoses). Alternatively, it is possible to transplant lymph nodes together with their vessels (microvascular lymph node transfer). Here a current report by Tele Züri on this topic.

Beyond this, lymphatic vessel surgery is employed to remove chronic fluid collections of wound sites (serum, lymphoceles). In these procedures, the tiny severed lymphatic vessels are marked with a dye/stain, then identified by microscope and tied off. Alternatively, they can be reconnected, or else connected to small veins (lympho-venous or lympho-lymphatic anastomoses).

Patients with difficult to treat lymphedema, or lymphedema associated problems, are discussed in conjunction with the Angiology Clinic and with Physical Therapy at the interdisciplinary lymphedema panel.