Indication and Technique of Reconstructive Lymph Vascular Surgery

Abstract

A locally interrupted or impaired lymphatic system is treated by a direct connection of major lymphatic vessels in front and behind the respective area by the patient’s own lymphatic vessel grafts. The grafts are harvested from the ventromedial bundle at the thigh which contains about 16 lymphatic vessels.

Local interruptions are mostly due to a treatment procedure, infection, or trauma at the narrow parts of the lymphatic system at lymph node areas.

The lymphatic to lymphatic anastomoses can be performed either in an end-to-end or in an end-to-side fashion. Alternatively, lymphatic vessels can be connected to lymph nodes draining the lymph into the marginal sinuses through a small incision in the lymph node capsule.

In arm lymphedemas, ascending collectors at the upper arm and lymphatic collectors or lymph nodes at the neck are connected by the grafts.

In unilateral leg edemas, the grafts are transposed to the affected limb and anastomosed to ascending lymphatic main collectors below the groin.

Primary lymphedemas due to a local impairment of the lymphatic system can also be treated using a lymphatic bypass procedure if harvesting is possible.

Lymphoceles and lymphatic fistulas can be treated by isolating the incoming lymphatic vessels and connecting them with grafts or transposing them.