Microvenous grafts in reconstructive lymphatic microsurgery: 7 years' clinical results

The author reports his experience with 32 cases of lymphatic-venous-lymphatic anastomoses (LVLA), an alternative microsurgical solution, personally conceived, proposed for the treatment of chronic lymphedemas of limbs, particularly in those cases in which there exists a venous disease associated with the lymphatic one in the same limb and, therefore, in which the most common lymphatic-venous anastomoses (LVA) would not be indicated. The preliminary diagnostic investigations, including lymphoscintigraphy, lymphography, and above all, the venous flowmetry and manometry be Doppler's method, play an important role in a precise choice of the indications for this kind of microsurgical technique, for they allow the investigator to point out, besides the lymphatic stasis, a more or less disguised venous pathology. The author's microsurgical method consists in the interposition of venous grafts, more or less long and with a suitable caliber, between lymphatic vessels placed upon and below the obstacle to the lymphatic circulation of the limb. The results of this personal LVLA microsurgical technique proved to be very satisfactory. All 32 cases treated by this method showed a significant and permanent decrease of the edema, with a follow-up till five years after operation.