Successful treatments for Lymphedema remain a constant challenging task for patients and their doctors, however, most cases of Primary and Secondary Lymphedema can be satisfactorily well managed by conservative measures such as manual lymph drainage, combined decongestive therapy, massage, and wearing compression garments.
Previous surgical techniques attempted to treat Lymphedema by stripping out the lymph fluid-filled subcutaneous tissues and building a lymphatic system bypass, in order to eliminate the affected tissues, or augment lymph fluid flow from the afflicted limb through alternate drainage routes, and, although at first thought, improvements may be possible with surgical procedures, they should only be considered as a very last resort for the worst cases, after all other options have failed, because no known surgical procedures can cure Lymphedema.
Direct lymphatic system to venous anastomoses have also been attempted, but each one of the most popularly performed surgical procedures for Lymphedema treatment has its own well known draw backs, including complete failure, repeated procedures, increased Lymphedema, and skin grafts being required after the surgery has been performed.
In 1912 the Kondolean Procedure, one of the earliest Lymphedema techniques, was used in an effort to remove affected subcutaneous tissues, and create fascial windows, to establish communications between the deep and superficial lymphatic systems. The Kondolean Procedure failed to work properly because deep fascias regrow.
The Charles Procedure, another Lymphedema surgical technique used in 1912, attempted to resect, or remove, affected subcutaneous tissues down to the muscle fascias, and cover the afflicted areas with skin grafts from the removed tissues.
The 1936 Homans-Miller Procedure removed lymphedematous tissues down to the fascia muscles, and used thin skin flaps to cover the areas the tissues were removed from. The procedure achieved good asthetic results, and is the standard ablative treatment approach used for forearm and upper extremity Lymphedema, however, second and third operations are frequently required to obtain the benefits of this procedure.
The Thompson Procedure combined elements of the Charles and Homans-Miller techniques, along with debulking and skin flaps sewn to the muscles of the affected limbs, however, the results were doubtful, and the procedure has been mostly discarded as a failure.
The Thompson Procedure also attempted to combine dermal lymphatics with deep lymphatic systems, and bury deepithelialized dermal flaps, for communications between the deep and superficial subcutaneous tissues. The procedure is not popularly used because of questionable viability of flap patterns.
These surgical procedures for treating Lymphedema are contraindicated, which makes them inadvisable, except perhaps for the absolutely most advanced severe cases, such as Filariasis, because these invasive procedures can increase the severity of Lymphedema. Other high risk factors of these surgical treatments are that blocked bypass tracts have occurred shortly after the procedures have been perfomed, they can create the possibility lymphatic valvular functions may become completely lost, and there is the probability for them to be successful several anastomoses would be required in the earliest stages of Lymphedema.
Debulking And Lymphatic Reconstruction:
Are Lymphedema surgical procedures advisable for the majority of patients suffering from the ailment? With the exceptions of debulking and lymphatic reconstruction, very doubtful, and like all other medical procedures, patients need to discuss these techniques with their medical team before they are performed.
Previously: Aagenaes Syndrome.
Next Time: Elephantiasis.