Fibrosclerotic lymphedema: pathophysiology and therapy.

We describe our experience with 12 patients with severe fibrotic lymphedema treated between 1979 and 1987. Each patient initially underwent nonoperative treatment (postural drainage and pneumatic compression) and in 10 patients who required operation, these measures were continued postoperatively. Operation included excision of subcutaneous tissue (debulking), which was extensive in 8 and limited in 2 patients. Only 2 patients were satisfactorily managed by nonoperative treatment alone. Based on the extensive pathophysiologic changes that occur in the tissue microenvironment with lymph stasis, it is unlikely that at this advanced stage of lymphedema that nonoperative treatment alone or "physiologic" operations such as lymphatic-venous shunt or lymphatic collector reconstruction is satisfactory. Rather, nearly all such patients require limited or extensive excision of the fibrotic-edematous subcutaneous tissue.