THE PROBLEMS OF LYMPHATIC MICROSURGERY FOR LYMPHEDEMA

Abstract

The problems of microsurgery for lymphedema  con­sist of the discrepancy between the excellent technical possibilities, especially of microsurgical lym­pho-venous shunts and the subsequently insufficient reduction of the lymphedematous tissue fibrosis and sclerosis. Generally, the lymphatic surgeon considers the lymphatic system to be a canalicular system of drainage tubes, of lymph collectors. Bypassing a  lymph  block  through  peripheral  lympho-venous shunts should therefore solve the problem of lymph­ stasis, present in each type of lymphedema. In  chronic lymphedema however, not only the canalicular lymphatic system, but  also the  tissues, an integral  part of the lymphatic  system, are affected.  In  chronic lymphedema, canalicular repair, for reasons of quantitative lymph drainage, exceptionally only provides a "restitutio ad integrum"  of  the  tissues, altered by lymph stasis.