The treatment of lymphedema of the extremities with microsurgical lympho-venous anastomoses.

Personal 20-years clinical experience in diagnosis and treatment of various types of lymphedema of the lower limbs with microsurgical lymph node-vein and lymph vessel-vein anastomoses is presented. Optimizing of diagnostic method, improvements in operation technique and results of the follow-up have, during that period of time, modified indications for surgical therapy of lymphedema toward a more conservative approach and applying microsurgical methods to a carefully selected group. At present, lympho-venous shunts are performed in patients with local, segmental obstruction of proximal lymphatics. Peripheral lymph vessels should be patent and have their contractility at least partly preserved. Long-term penicillin therapy is indispensable prior to surgery in cases with a history of lymphangitis. The diagnostic procedures necessary for proper evaluation of the degree of lymph stasis, including the technique of lymph pressure and flow measurements are described. The details of operation of lymphovenous shunts based on personal experience are presented.