Treatment of lymphedemas by microsurgical lymphatic grafting: what is proved?

Lymphedemas due to a local blockade of the lymphatic system can be treated by bridging the defect with autologous lymphatic grafts. Under the microscope, grafts are anastomosed to peripheral lymphatics distal to and central lymphatics proximal to the regional blockade. In this way, the diminished transport capacity can be restored. In the case of unilateral blockade at the groin or pelvis, the grafts connect the lymphatics of the thigh of the affected leg with lymphatics in the contralateral healthy groin. Between June of 1980 and December of 1986, 55 patients with lymphedemas have been treated by lymphatic grafting. The effect of lymph vessel transplantation has been evaluated by volume measurements and lymphatic scintiscans, showing a persistent patency of grafts, improvement of the transport index, and a persistent reduction in volume of the affected limbs. The reduction reached a level of 80 percent in patients with a follow-up of at least 3 years. The transport index showed an improvement of 30 percent. Autologous lymph vessel transplantation has been shown to be a fundamental step toward the microsurgical treatment of lymphedema.