Download PDF
J Reconstr Microsurg 2016; 32(01): 034-041
DOI: 10.1055/s-0035-1554934
Invited Review
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Microsurgical Lymphatic Vessel Transplantation

Ruediger G. H. Baumeister
1   Consultant in Lymphology, Chirurgische Klinik Muenchen Bogenhausen, München, Germany
2   Division of Hand Surgery, Plastic- and Aesthetic Surgery, AUHP Klinik, Ludwig Maximilians University of Munich, Muenchen, Germany
,
Weiss Mayo
3   Department of Nuclear Medicine, Ludwig Maximilians University of Munich, München, Germany
,
Mike Notohamiprodjo
4   Institute for Cinical Radiology, Ludwig Maximilians University of Munich, München, Germany
,
Jens Wallmichrath
2   Division of Hand Surgery, Plastic- and Aesthetic Surgery, AUHP Klinik, Ludwig Maximilians University of Munich, Muenchen, Germany
,
Stephanie Springer
2   Division of Hand Surgery, Plastic- and Aesthetic Surgery, AUHP Klinik, Ludwig Maximilians University of Munich, Muenchen, Germany
,
Andreas Frick
2   Division of Hand Surgery, Plastic- and Aesthetic Surgery, AUHP Klinik, Ludwig Maximilians University of Munich, Muenchen, Germany
› Author Affiliations
Further Information

Publication History

22 February 2015

28 March 2015

Publication Date:
10 July 2015 (online)

    Permissions and Reprints

Abstract

Background Lymphedema often arises after a regional interruption during cancer treatment, for example after lymph node resection the axilla or the groin. Lymphatic vessels as vascular grafts may overcome these lymphatic gaps.

Method Experiments in rats and dogs were performed for developing this method. Volume measurements, lymphoscintigraphies, proof of patency by MRI and radiology as well as quality of life studies were performed in patients.

Results Long-term follow-up studies revealed significantly reduced volumes, significant improvement of lymphatic outflow shown by lymphoscintigraphy, long-term patency of the grafts for more than 10 years, and improved quality of life after surgery compared with the situation with conservative treatment before surgery.

Conclusion Vascular grafts using the patients own lymphatic vessels are able to successfully reconstruct a locally interrupted lymphatic pathway.

Keywords

lymphedema - lymphatic vessel - vascular graft - microsurgery
 

  • References

  • 1 Degni M. New technique of lymphatic-venous anastomosis for the treatment of lymphedema. J Cardiovasc Surg (Torino) 1978; 19 (6) 577-580
    PubMedGoogle Scholar
  • 2 Nielubowicz J, Olszewski W. Surgical lymphaticovenous shunts in patients with secondary lymphoedema. Br J Surg 1968; 55 (6) 440-442
    CrossrefPubMedGoogle Scholar
  • 3 O'Brien BM, Sykes P, Threlfall GN, Browning FS. Microlymphaticovenous anastomoses for obstructive lymphedema. Plast Reconstr Surg 1977; 60 (2) 197-211
    CrossrefPubMedGoogle Scholar
  • 4 Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000; 16 (6) 437-442
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Becker C, Hidden G, Godart S, Maurage H, Pecking A. Free lymphatic transplant. Eur J Lymphol Relat Problems 1991; 2: 75-77
    PubMedGoogle Scholar
  • 6 Baumeister RG, Seifert J, Hahn D. Autotransplantation of lymphatic vessels. (Letter) Lancet 1981; 1 (8212) 147
    PubMedGoogle Scholar
  • 7 Baumeister RG, Seifert J, Wiebecke B, Hahn D , Experimental Basis and First Clinical Application of Clinical Lymph Vessel Transplantation of Secondary Lymphedema. Experimental basis and first application of clinical lymph vessel transplantation of secondary lymphedema. World J Surg 1981; 5 (3) 401-407
    CrossrefPubMedGoogle Scholar
  • 8 Baumeister RGH, Siuda S. Treatment of lymphedemas by microsurgical lymphatic grafting: what is proved?. Plast Reconstr Surg 1990; 85 (1) 64-74 , discussion 75–76
    CrossrefPubMedGoogle Scholar
  • 9 Baumeister RG, Seifert J, Wiebecke B. Transplantation of lymph vessels on rats as well as a first therapeutic application on the experimental lymphedema of the dog. Eur Surg Res Clin Exp Surg 1980; 12 (Suppl. 02) 7
    PubMedGoogle Scholar
  • 10 Baumeister RG, Seifert J, Wiebecke B. Homologous and autologous experimental lymph vessel transplantation: initial experience. Int J Microsurg 1981; 3: 19-24
    PubMedGoogle Scholar
  • 11 Baumeister RG, Seifert J, Wiebecke B. Untersuchungen zum Verhalten von resorbierbarem und nicht resorbierbarem Nahtmaterial bei der Lymphgefäßnaht. Handchirurgie 1982; 14: 87-91
    PubMedGoogle Scholar
  • 12 Clodius L. The experimental basis for the surgical treatment of lymphedema. In: Clodius L, ed. Lymphedema. Stuttgart, Germany: Thieme; 1977: 43-77
    Google Scholar
  • 13 Wallmichrath J, Baumeister RGH, Deglmann CJ, Greiner A, Heim S, Frick A. Technique and proof of patency of microsurgical lympho-lymphonodular anastomoses: a study in the rat model. Microsurgery 2009; 29 (4) 303-309
    CrossrefPubMedGoogle Scholar
  • 14 Kuhnke E. Volumenbestimmungen aus Umfangsmessungen. Folia Angiol 1976; 24: 228
    PubMedGoogle Scholar
  • 15 Weiss M, Baumeister RGH, Hahn K. Planning and monitoring of autologous lymph vessel transplantation by means of nuclear medicine lymphoscintigraphy [in German]. Handchir Mikrochir Plast Chir 2003; 35 (4) 210-215
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Weiss M, Baumeister RGH, Tatsch K, Hahn K. Lymphoscintigraphy for non-invasive long term follow-up of functional outcome in patients with autologous lymph vessel transplantation [in German]. Nucl Med (Stuttg) 1996; 35 (6) 236-242
    PubMedGoogle Scholar
  • 17 Weiss M, Baumeister RGH, Hahn K. Post-therapeutic lymphedema: scintigraphy before and after autologous lymph vessel transplantation: 8 years of long-term follow-up. Clin Nucl Med 2002; 27 (11) 788-792
    CrossrefPubMedGoogle Scholar
  • 18 Notohamiprodjo M, Baumeister RGH, Jakobs TF , et al. MR-lymphangiography at 3.0 T—a feasibility study. Eur Radiol 2009; 19 (11) 2771-2778
    CrossrefPubMedGoogle Scholar
  • 19 Danese C, Bower R, Howard J. Experimental Anastomosis of Lymphatics. Arch Surg 1962; 84: 24
    PubMedGoogle Scholar
  • 20 Springer S, Koller M, Baumeister RGH, Frick A. Changes in quality of life of patients with lymphedema after lymphatic vessel transplantation. Lymphology 2011; 44 (2) 65-71
    PubMedGoogle Scholar