The surgical management of lymphedema.

The treatment of lymphedema remains a formidable task for the patient and physician. However, most patients with both primary and secondary lymphedema can be managed satisfactorily by conservative means. Surgical intervention for lymphedema should be considered only after a serious trial of medical management. Although no present surgical technique offers cure, significant improvement is possible by a variety of methods. The staged excision of skin and subcutaneous tissue, the Charles procedure and the dermal flap by Thompson are still the most popular techniques in the United States. Axial and myocutaneous flaps and microsurgical bypass procedures are currently under investigation and may hold promise after additional study. Future experimental and clinical studies should concentrate on long term follow-up study with objective clinical and roentgenographic documentation of improvement.