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.
