The problems of lymphatic microsurgery for lymphedema

The problems of microsurgery for lymphedema consist of the discrepancy between the excellent technical possibilities, especially of microsurgical lympho-venous shunts and the subsequently insufficient reduction of the lymphedematous tissue fibrosis and sclerosis. Generally, the lymphatic surgeon considers the lymphatic system to be a canalicular system of drainage tubes, of lymph collectors. Bypassing a lymph block through peripheral lympho-venous shunts should therefore solve the problem of lymphstasis, present in each type of lymphedema. In chronic lymphedema however, not only the canalicular lymphatic system, but also the tissues, an integral part of the lymphatic system, are affected. In chronic lymphedema, canalicular repair, for reasons of quantitative lymph drainage, exceptionally only provides a 'restitutio ad integrum' of the tissues, altered by lymph stasis.