Microsurgery for Lymphedema: a Real Possibility of Cure

The first microsurgical derivative operations were those using lymphnodal-venous shunts. These have been largely abandoned, except in endemic areas of lymphatic filariasis such as India where thousands of these procedures have been performed. Lymphatic channels in lymphnodal-venous anastomoses are often widely dilated due to the high rate of anastomotic closures caused by the thrombogenic effect of lymph nodal pulp on the venous blood and the frequent re-endothelization of the lymph nodal surface (1). Because of the difficulties encountered with lymphnodal-venous shunts by surgeons worldwide, the next approach was to use lymphatic vessels directly anastomosed to veins (2).