Microlymphatic surgery in management of lymphoedema of the upper limb

Microlymphatic surgery is a recent addition to the range of surgical procedures for lymphoedema. Lymphaticovenous anastomosis is the most direct approach to the basic cause of obstructive lymphoedema bypassing the obstruction of the axilla or groin. With increased experience the overall results have improved and, in selective cases, segmental reduction is carried out either at the same operation or at a later date. Microlymphatic surgery in conjunction with segmental reduction of the upper arm is aesthetically and functionally most acceptable. The most significant effect of lymphaticovenous anastomosis in relieving the lymphoedema of the upper limb is over the dorsum of the hand and lower forearm. At least two, or more if possible, lymphaticovenous anastomoses are required for effectiveness of the procedure. Besides subjective and objective improvement in the lymphoedema there is significant reduction in frequency of cellulitis following lymphaticovenous anastomoses. The technique, along with the results and follow-up over 5 years is presented.