Surgical treatment of lymphedema--a reappraisal.

The clinical picture of lymphedema and its classification have been briefly reviewed with a discussion of surgical treatment both historical and current. It has been pointed out that the primary mode of treatment of congenital or secondary lymphedema of the extremities is intensive medical therapy and that surgical intervention is warranted in only rare and unusual circumstances. The gamut of surgical procedures attempted have been reviewed and it is this author's contention that the only procedure of limited, worthwhile value is a combination of the Kondoleon and the Thompson procedures. The Kondoleon phase of the procedure debulks the extremity in stages and removes the deep fascia. The Thompson form of the procedure advances a deepithelialized dermal flap into the deep lymphatical venous system. It has not been conclusively proven whether this dermal flap is of significant physiologic benefit, but I feel it is worth adding this to the Kondoleon procedure so that in time, we will have an opportunity to evaluate the value of this phase of the procedure.