[Microsurgical lympho-venous anastomosis in the treatment of secondary lymphoedema of the upper extremity].

At the end of the 1960's, lymphonodo-venous anastomosis has been performed by Olszewski and Nielubowicz experimentally as well as in clinical cases. Later on, various authors performed in clinical cases microsurgical anastomoses between lymphcollectors and veins. The rationality of this procedure is based on the knowledge that lymph always find the way back to the venous system, that the pressure of the lymph vessels is higher than in venous system of the extremities and that competent valves guarantee a centripetal flow. Beginning in the middle of the 1980's, we performed microsurgical end-to-end lympho-venous anastomoses in invagination technique for the treatment of secondary arm lymphoedema. The operation can be performed in local anesthesia, the anastomoses are performed on the proximal lower arm and on the medial portion of the upper arm. In each localisation three to four lympho-venous anastomoses are performed. Not only subjectively there is a decrease of the complaints but also variable reduction of the volume of the edematous arms can be achieved. In average the volume-reduction reaches 30 %. Data of a follow-up of 53 patients up to ten years show stable results. This is a long-standing benefit and supports further conservative therapy as manual lymphdrainage. Nevertheless lymphoedema is a chronical and irreversible disease which cannot be definitively cured with operative or with conservative procedures.