title: [Update on special surgical approaches in the therapy for lymphedemas].
abstract: Despite recent medical progress primary and secondary lymphedemas still represent a therapeutic challenge and they often lead to a significant reduction in quality of life. Lymphedemas usually develop in the extremities, the male external genitals as well as the female breast as a consequence to the axial alignment of the lymphatic collectors. Early stages are characterized by an excess of lymph fluid increasing the volume of the affected part of the body whereas later stages represent an increasing amount of solid tissue. Thus therapeutic efforts can focus on the reduction of the surplus of liquid and/or solid components. Generally there are conservative and operative strategies. Conservative measures mainly focus on the improvement of fluid mobilization and drainage and comprise compression garments, manual lymphatic drainage, and apparative intermittent compression. Operative approaches comprise procedures for surgical tissue reduction (symptomatic/ablative approaches) and/or procedures with the intention of enhancing lymphatic transport (causal approaches). Surgical tissue reduction can be performed by open resection and/or liposuction. Traditional surgical causal techniques such as transposition of local flaps aim at leading lymph away from the congested region of the body. Modern microsurgical causal approaches contain methods of reconstruction of interrupted lymphatic pathways as well as techniques for the conduction of lymph into local veins. In this review we depict and discuss the features of the multiform spectrum of the surgical therapy of lymphedemas on the basis of literature as well as our own clinical and experimental experience.
authors.affiliation: Handchirurgie, Plastische Chirurgie, Äshetische Chirurgie, Klinikum der Ludwig-Maximilians Universität, Marchioninistraße 15, 81377 München. jens.wallmichrath@med.uni-muenchen.de
authors.forename: J
authors.initials: J
authors.lastname: Wallmichrath
authors.forename: R
authors.initials: R
authors.lastname: Baumeister
authors.forename: R E
authors.initials: RE
authors.lastname: Giunta
authors.forename: M
authors.initials: M
authors.lastname: Notohamiprodjo
authors.forename: A
authors.initials: A
authors.lastname: Frick
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D058128:Compression Bandages; D004322:Drainage / Q000379:methods; D005121:Extremities / Q000601:surgery; D006801:Humans; D015187:Lipectomy / Q000379:methods; D008196:Lymph / Q000502:physiology; D042601:Lymphatic Vessels / Q000601:surgery; D008209:Lymphedema / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008221:Lymphoid Tissue / Q000503:physiopathology / Q000601:surgery; D008866:Microsurgery / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps; D014680:Veins / Q000637:transplantation