Treatment of Peripheral Lymphedema by Microsurgical Anastomoses of Lymphatics with ValvularVein

From: The U.S. Chinese Journal of Lymphology and Oncology

Lisheng Li Weigang Gao Shanliang Wang Tisheng Chang

Abstract Objective

Lymphatic microsurgery has been one of the top choices in the treatment of obstructive lymphedema of extremities that are not responsive to conservative method. The major drawback of this method is the possible blood reflux from vein to lymphatics after lymphatics-vein anastomoses. To keep the one way flow at the lymphatics-vein anastomoses site, We explored a new way to anastomose the lymphatics with the adjacent valvular veins with patent valve.

Methods

Fifty-six cases (16 postmastectomy arm lymphedema, and 40 leg lymphedema) with chronic limb lymphedema underwent lymphatics-vein shunts by microsurgical anastomoses of lymphatics with valvular vein either from adjacent veins at the obstructed area or autogenous vein grafts from the distal segment of the V. Saphena magna or/and its collateral branches in the medial surface of the leg. Results The patients were followed up for 12 to 56 months. A moderate elastic support was generally applied to the affected limb postoperatively. The study demonstrated very good results in 57% of the patients(32 patients), good in 30%(17 patients)and fairly good in 9%(5 patients),null in 4%(2 patients) in the follow-up period of 12 to 55 months after lymphatic microsurgery.

Conlusion

Anastomoses of lymphatics with valvular veins have been proved clinically to be very effective with very good and good results in 87% of the patients (49/56) in our series of cases with chronic lymphedema of extremities. It is supposed that the existed valves in the vein may play an essential role in maintaining one-way flow of lymph through the lymphatics-vein anastomoses site after operation and attaining the steady results of lymphedema regression.

Key Words:

Chronic lymphedema; lymphatics-Vein anastomoses; microsurgical treatment

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There is evidently extensive research being done in China on lymphedema. As I can find information and status studies, I'll post them. Interesting cutting edge research.

Pat