Microsurgical treatment of lymphedemas of the limbs

Lymphaticovenous anastomosis for surgical treatment of lymphedema of the limbs has been performed for several years with good results. The authors report on their experience, gained since 1976, after having operated on primary or secondary lymphedemas (five upper and 15 lower limbs). Lymphaticovenous anastomosis was performed according to Degni's technique using a special needle by which lymphatic vessels are inserted into the vein and secured to its wall. Eighty-three percent of the subjective results were good, and the percentage of mean volumetric reduction in the operated limbs was 43% in 16 controlled cases. The postoperative course of secondary lymphedemas of the upper limbs was sometimes complicated by sudden lymphangitis attacks. In dealing with primary lymphedemas, the best results were obtained when all the operated limbs had large volumetric reduction, allowing the patients to resume their normal activities. The authors conclude that, after a long period of preoperative anti-inflammatory and anti-microbial therapy and regardless of lymphographic patterns, it is always worthwhile to perform a surgical exploration of the crural lymph nodes.