Lymph graft, lymph lymph anastomosis
Lymph graft is free from lymphatic duct occlusion by venous blood which can occur with lymphovenous anastomosis. In lateral lymphedema, the lymphatic duct on the healthy side is harvest for transplantation and pre-surgical lymphscintigraphy is needed. In a patient with history of lumpectomy, several lymphatic ducts of the leg are grafted in the arm. The one end of the lymphatic duct descending from the neck is connected at the site of surgery and the other end is connected to the healthy lymphatic duct around the fascia of the arm. In the leg, rotation flap technique is carried out where a flap of the normal lymphatic duct is taken and transferred to the lesion. Baumeister Siuda reported that the surgery had 80% efficacy and the transport capacity of the lymphatic duct was maintained for three years. However, this surgery cannot be said to have long-term efficacy.
Lymph Vein Lymph Graft
This method can be used in congenital lymphatic duct occlusion and segmental lymphatic duct occlusion. It had 75% efficacy among 133 patients with early stage secondary lymphedema and overall 50% efficacy in long-term follow-up.
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Free lymphatic flap autotransplantation
Trevidic and Keolmeyer reported that transplanting the inferior axillary gland including latissimus dorsi and skin of the healthy side to the lesion had 75% efficacy.
Other techniques of microsurgery are being developed besides the ones mentioned above. Despite such advancement, microsurgery is rarely performed because it is a difficult procedure using 20X magnification, time-consuming (5-10 hours under general anesthesia), costly and few surgeons have expertise in the procedure. Microsurgery is becoming more popular in the US, however, at least 2-3 years of follow-up is needed to evaluate the outcome. Continuous compression therapy is needed after surgery.
-To be continued
