Microlymphaticovenous anastomosis in the treatment of lower limb obstructive lymphedema: analysis of 91 cases

Since 1980, 110 cases of lymphedema have been treated by microlymphaticovenous anastomosis. Of these 110 patients, 91 with obstructive lymphedema of lower limbs were reviewed. The immediate and long-term results have been very satisfactory. Excellent and good results were obtained in 79.1 percent. An average reduction in circumference of the affected limb of 6.4 cm and an average reduction of excess volume of 59.2 +/- 29.5 percent (representing 703 +/- 850 ml) were obtained. Subjective symptoms and objective signs were improved. Four patients (4.4 percent) showed poor results owing to severe fibrosis of neighboring tissue; no lymphatics could be located for anastomosis. As the authors gained experience with the operation over the last 3 years, they modified the operative procedure, the anastomotic technique, and the selection of collective lymphatics. The data obtained suggest that the quality of results is proportional to the number of anastomoses. In order to obtain the best results, the criteria for selection of patients and avoidance of postoperative relapse are discussed. Finally, a test for determination of the indications for microlymphatic surgery is described.

Microlymphaticovenous anastomosis for treating scrotal elephantiasis

Scrotal elephantiasis can be physically disabling and psychologically distressing to the victim. Ablative procedure has been used in its treatment and has achieved limited success. The authors developed a microlymphaticovenous procedure to treat elephantiasis of the scrotum and applied it clinically in three patients. The immediate and long-term (13-24 months) results have been very satisfactory. The scrotum size was dramatically reduced to a nearly normal level, and subjective symptoms and objective signs were improved. The operative techniques are described, the three case histories are illustrated, and the advantages of microlymphaticovenous anastomosis, the selection of patients, and the factors required for success of the surgery are discussed.

Microlymphaticovenous anastomosis for lymphedema of the breast

On the basis of microlymphaticovenous anastomosis for treating lymphedema of the extremities, the authors developed a microlymphaticovenous procedure to treat congenital lymphedema of the breast and applied it clinically in two patients. The immediate results have been fairly good. The breast and its nipple had been reduced in size and to a nearly normal level. The results are maintained after a half year of follow-up. The fundamentals and techniques of the operation are described and the two case histories are reported. The cases presented here appear to be the first successful clinical attempts to treat lymphedema of the breast by microlymphaticovenous anastomosis. The clinical character of congenital lymphedema, the indication of the microlymphaticovenous anastomosis, and the factors required for success of microlymphatic surgery are discussed.

Contracture of the adductor pollicis and the first dorsal interosseous muscles

Trauma, infection, local injections and even acupuncture may cause fibrosis of the muscles of the first web space of the hand, leading to severe malposition and loss of function of the thumb and index finger. The authors present the anatomical basis for the deformity and the results of surgical treatment by tenotomy or tendon lengthening in 120 hands in 79 patients. Operation produced an excellent result in the majority of cases and the outcome was independent of the severity of the deformity or the duration of the condition.

Microvascular free transfer of iliac bone based on the deep circumflex iliac vessels

The findings from dissections, injection studies, and angiograms of 180 specimens of the anterior portion of left and right iliac crests taken from 90 cadavers are reported. These findings suggested that the deep circumflex iliac vessels were suitable for use as a nutritive pedicle in microvascular free transfer of iliac bone. Therefore, the technique of microvascular free transfer of iliac bone based on these vessels was developed and applied clinically in 2 cases with good results. The advantages and disadvantages of using the superficial circumflex iliac vessels or the deep circumflex iliac vessels as the vascular pedicle for iliac grafts also are discussed.