Microlymphatic bypass in obstructive lymphoedema

A small series of patients with obstructive or secondary lymphoedema treated by microlymphatic bypass is presented. The procedures in the lower and upper limbs are described. Preoperative assessment by lymphangiography and lymphoscintigraphy are required to assess suitability for the procedure. Postoperatively, patent lymph collectors can be demonstrated by lymphoscintigraphy. Microlymphatic bypass must be carried out before the peripheral lymph collectors have been destroyed or permanently damaged by increasing back pressure and recurrent infection. Factors influencing a successful result are enumerated. Other microsurgical techniques and treatment are reviewed.