Restoration of lymph drainage after extremity replantation

A clinical analysis of 171 major extremity replantations was carried out. From one month to 2.5 years after surgery, direct lymphographic studies of replanted limbs were done in 17 patients (16 upper limbs and one lower limb). Despite a complete disruption of lymphatic drainage, replanted limbs underwent adaptive and compensatory structural changes of the lymphatic system in the post-replantation period; first, with regeneration of cutaneous vessels and then (after six to eight weeks postoperatively) with regeneration of lymphatic collecting vessels. Such changes led to improvement as early as four to six weeks postoperatively and subsequently to restoration of lymphatic drainage in the replanted limb. The rate and extent of lymphatic recovery depends largely on the surgical techniques used in replantation.