The dawn of a new era in surgery for lymphedema

概要

Although a considerable number of publications about the treatment of lymphedema has been appeared in recent years, an effective method for surgical treatment has not yet been established. In legs of adult mongrel dogs the author made a lymphatic venous end-to-end anastomosis with 4 to 6 evenly-spaced, interrupted sutures of No. 10-0 black tetron monoffla- ment. All branches of the sapheneus vein were ligated and cut off to prevent venous blood inflow. Consequently the saphenous vein was transformed into a lymphatic channels. At the site of the anastomosis, the author amputated the lymphatic venous anastomosed leg and the control leg except their bones, arteries, veins and nerves and relsutured them respectively for formation of lymphedema. The author examined the relationship between lymphatic and venous pressure at rest or in the manual pumping procedures. In the present study, lymphpressure ascended abruptly during manual pumping more than venous pressure. In the amputated leg having an end-to-end anastomosis, the author succeeded to demonstrate the passage of a contrast medium through the anastomosis by indirect lymphangiography, and circumferences of the lymphatic venous anastomosed leg were less than those of the control leg. The main cause of failure of anastomosis was presence of excess granulation tissue at the anastomotic site and anastomotic disruption. By using No. 10-0 black tetron monofilament, however, the granulation was not prominent histologically. Therefore, the author applied this method to a patient with lymphedema clinically, and obtained considerable effects.