Surgical management of selected patients with lymphedema of the extremities.

In the management of moderately severe lymphedema of the extremities, two types of "physiological" surgery have been employed with acceptable results. The methods involve (1) subcutaneous drainage of lymph by a synthetic suture network or loops of #2 prolene and (2) lymphatic-venous anastomosis of lymphatic channels into adjacent superficial veins. In 126 patients treated by the first method, there was an average reduction of edema of approximately 60%. In 77 patients the second method (306 anastomoses) resulted in an average reduction of edema of 75% in follow-up rangeing up to 11 years. These procedures are contraindicated in patients with limb paralysis or frequent recurrent skin infection.