[Problems of microsurgery in lymphedema].

Microsurgery for primary and secondary lymphedema at present consists of shunts between lymphatic vessels and veins. The surgical technique has been well established for more than a decade. The problems consist of the irreversible changes in the peripheral lymphatic system and in the connective tissues, as well as the obliteration of the deep lymphatics, best suited for lymphaticovenous anastomoses. These changes are recognized only late, after clinical swelling becomes manifest. Therefore, lymphaticovenous shunts should be performed prophylactically. Their number should be sufficiently high to solve the quantitative problem, caused by the reduced lymphatic transport capacity.