Outcome of lymphedema after microsurgical treatment

Lymphedema is a chronic disease with accumulation of water and proteins in the tissue, secondary to impairment of the lymphatic transport capacity. Nowadays, probably millions of persons worldwide are suffering from the disease. Lymphedema can be primary (congenital) or secondary (acquired after e.g. lymph node excision, radiotherapy, recurrent episodes of lymphangitis). The extremities are mostly affected although it can be present at every part of the body. Clinical parameters of lymphedema vary from swelling and recurrent infections (erysipelas) up to disability in end-stage disease because of inflammation and fibrosis in the affected limb. Although lymphedema is a chronic disease, the severity of the edema can be reduced by conservative treatment in many patients. The conservative approach comprises the association of manual lymph drainage, multilayer bandaging (short stretch bandages), physical exercises and skin care. Lifelong use of elastic stockings is mandatory. In patients that respond suboptimally to conservative treatment, one can find benefits associating surgical treatment. The aim of surgery in those cases is to reduce the size of the affected limb, to minimize recurrent episodes of lymphangitis and to improve limb function. A variety of surgical procedures have been applied. Currently, three types of surgical options exist. In reconstructive microsurgery, the interrupted lymphatic system is repaired by the interposition of a homologous vein or lymphatic collector 1,2. In contrast, derivative microsurgical procedures 3,4,5,6,7 aim to deviate the excess of lymphatic flow towards the venous system. A second type of surgery is the liposuction/lipectomy procedure 8 where the excess of fat accumulation after chronic THE EUROPEAN JOURNAL OF lymphology