Various Lymphatic Reconstructive Surgeries Based on Pathophysiology of Lymphatic Vessel-related Diseases

Abstract

Lymphatic vessel-related diseases include various pathophysiologic conditions, among which lymphatic reconstructions are indicated in lympho-rrhea/-cyst (LR/LC) with lymphatic vessel rupture, and lymphedema (LE) with lymph flow obstruction. In both pathologic conditions, precise lymph flow evaluation is a key to successful management. It is recommended to reconstruct lymph flow of identified ruptured lymphatic vessels with lymphatico-lympahtic anastomosis (LLA) or lymphaticovenular anastomosis (LVA) for the treatment for intractable LR/LC. LVA is considered for mild LE cases with less lymphosclerotic change, while vascularized lymph node transfer (LNT) for progressed LE with severe lymphosclerosis. Lymph-interpositional-flap transfer (LIFT) should be considered for cases with soft tissue and lymphatic defect. According to pathophysiology of lymphatic vessel-related diseases, appropriate treatments, such as LLA/LVA/LNT/LIFT, should be applied.