Lymphovenous Microsurgical Shunts in Treatment of Lymphedema of Lower Limbs: A 45-year Experience of One Surgeon/One Center.

Dec 2012

Olszewski WL.

Source

Department of Surgical Research & Transplantology, Medical Research Center, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland. Electronic address: wlo@cmdik.pal.pl.

Abstract

RATIONALE:

The use of microsurgical lymphovenous shunts is one of the generally accepted treatments for limb lymphedema.

AIM:

The 45-year personal experience of one surgeon in indications, technique and results of lymphovenous shunt operations in lower limb lymphedema of varying etiology is presented.

MATERIAL:

One thousand three hundred patients were followed up in the period 1966-2011. Patients were classified into groups according to the etiology of lymphedema as postinflammatory/posttraumatic, postsurgical, idiopathic and hyperplastic. Decrease in limb circumference, heaviness and pain, and increase in joint flexing were evaluated.

RESULTS:

The most satisfactory results, reaching 80-100% improvement, were obtained in the congenital non-hereditary hyperplastic lymphedema group, with large lymphatics not previously damaged by infection. Results were also satisfactory in the group of cancer patients after iliac lymphadenectomy, reaching 80%. A less satisfactory outcome was observed in the postinflammatory group, not exceeding 30-40%. In idiopathic lymphedema results were satisfactory in only a few cases.

CONCLUSIONS:

Patients with lymphedema with local segmental obstruction but still partly patent distal lymphatics and without an active inflammatory process in the skin, subcutaneous tissue and lymph vessels present satisfactory results.

**Editor's note:  Please understand this procedure while showing great promise is still classified as experimental.  Also, note the particular "types" of lymphedema and patients that appear to have the best results. See RESULTS - Pat**

PubMed

Computerized tomography of 150 cases of lymphedema of the leg

This is a very old abstract from 1998. What was fascinating to me personally, is the CT description of the leg tissue with lymphedema. It reminded me of the ones I have had on both legs.

In the early 1970's, I had three Thompsons procedures done on my left leg, and none done on the right. There is a noticeable difference internally for the legs. Strange too was the fact that after a week in the hospital last year, it was the left leg that experienced the greatest decrease in swelling - specifically due to the fact that according to the CT, it has a much smaller amount of subcutaneous tissue then the left.

Does that make the surgery worthwhile? Hardly, the complications, including lymphoma still make it a terrible choice for lymphedema treatment. It is also the only leg that has experienced cellulitis.

The abstract follows:

Computerized tomography of 150 cases of lymphedema of the leg

Nov 1998

[Article in French]

Marotel M, Cluzan R, Pascot M, Ghabboun S, Alliot F, Lasry JL.

Source

Hôpital Saint-Michel, Paris, France.

Abstract

The aim of this work was to evaluate the usefulness of CT imaging to stage lower limb lymphedemas. Between 1992 and 1997, we studied 150 cases of lymphedema, half idiopathic and half secondary. Methods used are described. In decreasing order of frequency, we found: skin thickening, increased subcutaneous tissue surface area compared with the healthy limb, thickening of the perimuscular aponevrosis, fat infiltration: lines parallel to the skin (parallel), edematous areas along the perimuscular aponevrosis, lines perpendicular to the skin (perpendicular). The lowest fat density was increased on the diseased side. The subfascial tissue showed some fat accumulation. These results were compared with findings reported in the literature. There were very major differences between idiopathic lymphedema and secondary lymphedema of the thigh. Similar images were generally generated by new and long-standing lymphedema. Rarely useful for positive diagnosis, CT is indispensable for establishing stage initially or after recent increase and, in our opinion, is essential for pretherapeutic assessment. The CT-scan gives objective evidence of overall disorders, the exact upper limit of the lymphedema, and sometimes reveals infraclinical bilateral involvement.

Full text arricle: EM/Consulte