Surgical therapy and, in particular, derivative and reconstructive microsurgery have recently been included in the combined, multimodal, and integrated treatment of both primary and secondary lymphedema, thus becoming standard professional know-how of physicians treating lymphatic system disorders. Microsurgical techniques adopted for “conservative and functional” lymphedema surgery are classified into derivative and reconstructive. Derivative techniques are by far the most common ones. They aim at resuming lymph flow by fashioning a lymph-venous drainage, using lymph nodes or, better, lymphatics directly that are being anastomized to the main satellite vein:
- Lymph node-Venous Anastomosis (LNVA);
- Lymphatic -Capsular-Venous Anastomosis (LCVA – Campisi, 1978);
- End-to-end Lymphatic -Venous Anastomosis (EE-LVA);
- End-to-side- Lymphatic -Venous Anastomosis (ES-LVA).
With reconstructive microsurgical techniques, lymph flow circulation is reinstated by by-passing the site of the block through the insert of autologous, either lymphatic or venous, segments, to join collectors upstream and downstream the obstacle:
- Lymphatic -Lymphatic Anastomosis (LLA);
- Segmental Lymphatic Vessel Autotransplantation (SLAT);
- Lymphatic-Venous-Lymphatic-Plasty or Lymphatic-Venous-Lymphatic Anastomosis (LVLA – Campisi, 1982);
- Free Lymphatic -Lymph Nodal Flaps (FLF).
The techniques that so far have proved to be more effective and that are most commonly applied in patients with chronic, primary or secondary, lymphedema of the extremities are LVA and LVLA, in patients with severe concurrent venous insufficiency.