Microlymphaticovenous anastomoses for obstructive lymphedema.

Microlymphatic surgery appears to have a worthwhile clinical application in the treatment of secondary obstructive lymphedema. We prefer 3 or more lymphaticovenous anastomoses at, or above, the elbow; otherwise ablative procedures are recommended. In the selected cases there are some advantages of anastomoses over surgical reduction procedures: (1) the incidence of postoperative cellulitis is significantly less; (2) the microlymphatic techniques are applicable to both upper and lower limbs and perhaps could be extended to localized cases of obstructive lymphedema following trauma and congenital constriction bands. Considerable experience in microvascular surgery is required for doing this type of work. A long-term evaluation of the results of microlymphatic surgery in obstructive secondary lymphedema is required before judging its potential--especially in view of the fluctuating history of lymphedema--but the results reported are encouraging.