[Surgical possibilities in lymphedema treatment]

Surgical measures in the lymphedema of the extremities require precise establishment of the indication. The current surgical techniques (tissue reduction, Thompson's operation, lympho-venous anastomosis) are of some benefit but also have disadvantages. For that reason, the choice of surgical method depends entirely on the individual case and the edema (primary or secondary) present. Primary lymphedema preferentially calls for the performance of tissue reduction or Thompson's operation. In secondary lymphedema, we prefer as a primary surgical measure the so-called lympho-venous anastomosis; this technique can be applied as long as the subcutaneous lean and fatty tissue is not fibrotic. We formerly applied the technique according to Degni and found that the results in terms of reduction of the edema were more promising in the lower than the upper limbs.