Evaluation of Thompson's buried dermal flap operation for lymphoedema of the limbs: A clinical and radioisotopic study

Abstract

SEARCH for an operation which will improve the lymphatic drainage from a lymphlogged limb continues. The buried dermal flap operation (Thompson, 1962, 1964, 1965) has been claimed to be a physiological operation on the assumption that anastomosis of the superficial lymphatics of the dermis and the lymphatics of the deeper compartment occurs, and also that lymphovenous communications develop between the transposed superficial lymphatics and the venules of the deeper compartment. This thesis is reasonable but so far no conclusive evidence has been. presented to show that these assumptions are correct. Thompson (1967) claimed that lymphatic drainage improves significantly after operation because of the more rapid clearance of Ii3’ tagged human serum albumin (RIHSA) from lymphoedematous upper limbs in 4 out of 5 patients. He also reported in a IO-year survey of 79 patients so treated “good” and “satisfactory” results in 92 per cent of cases of primary lymphoedema, in all cases (author’s italics) of secondary lymphoedema of the lower limb and in 94 per cent of the upper limbs treated (Thompson, 1970); In view of such impressive results, my interest was aroused and I have carried out the buried dermal strip operation in 5 cases of secondary lymphoedema of the leg. The follow-up period is up to 2 years and the results have been evaluated by direct circumferential measurement and RIHSA clearance. For the RIHSA clearance test 1-2~ Ci RIHSA was injected in the diseased leg and counting was done immediately after injection on a gamma scintillation counter (medical spectrometer) with a No. I, thallium activated crystal of 2 in diameter and ri in thickness, the probe having been placed over the site of injection and touching the skin. The standard was also counted simultaneously. Counting was done daily until the clearance reached above 90 per cent, the first reading of the counts at the time of injection having been taken as 0.0 per cent clearance. All the readings were corrected for natural decay and background. The percentage clearance of RIHSA in 24 hours, and the time in hours taken for 50 per cent clearance (T&) were then calculated.