ABSTRACT
The microsurgical lymphovenous anastomoses should be tried in patients with an obstructive type of lymphedema of relatively short duration, at least one or two collecting trunks still spontaneously contracting, and without any evident signs of skin and lymphatic vessel inflammation. In lymphedema, the swollen tissues are predominantly skin and subcutaneous tissue but not the muscles. Edema develops and is most visible in dependent parts of the extremity, that is, toes and foot then calf and thigh. Practically all patients with obstructive lymphedema suffer from subclinical dermatitis. The thickness of skin and subcutaneous tissue vs. muscles helps to differentiate between lymphedema and thrombophlebitis. Computer-assisted tomography seems to be even more helpful in difficult cases. Phlebography of peripheral and pelvic or axillary vessels is a valuable diagnostic adjunct, allowing detection of acquired venous abnormalities aggravating edema. It should be performed in all cases of edema, with the results being taken into consideration in the follow-up after microsurgical procedures on lymphatics.
