Lymphatic-Lymphatic Reconstructive Microsurgery
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Due to advanced microsurgery, it became possible to perform classic procedures in vascular surgery also within lymphatic vessels. As shown in extensive experimental studies, anastomoses within the lymphatic system have a very high patency rate. Lymphatic grafts also remain patent and are able to substitute the function of normal lymphatic vessels and to reverse an artificial lymphedema.
Lymphedemas due to localized interruptions, like most of lymphedemas in northern countries, are treated using lymphatic vessel grafts. These are harvested from the ventromedial bundle at the thigh and used either as free grafts, e.g., bypassing the axilla in arm edema or being transposed to the affected limb in unilateral leg lymphedema. Anastomoses are always performed within the lymphatic system. This respects the normal pressure gradient and takes advantage of the autonomic pumping ability of lymphatic vessels and the minimal coagulation activity of lymph.
The results show not only a significant reduction of volume in long-term follow-up studies but also a significant improvement in the quality of life. Lymphoscintigraphic follow-up studies proved the significant improvement of lymphatic transport up to a normalization. Further more direct visualization of patent grafts was possible more than 10 years after surgery.
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