Net Effect of Lymphaticovenous Anastomosis on Volume Reduction of Peripheral Lymphoedema after Complex Decongestive Physiotherapy

Abstract

Although we have come a long way from atrocities such as circumferential excision of all lymphoedematous tissue, modern microsurgical techniques to date have not been scrutinised sufficiently to fully establish their role in the treatment of chronic lymphoedema. In an admirable effort, at least, the authors have tried to isolate the effect of microsurgically created lymphovenous anastomoses from that of the concomitant decompressive regiments that these often desperate patients tend to undergo. Relative to the effects of complex lymphoedema therapy (CLT), the volume reduction obtained with side-to-end lymphovenous anastomosis is modest, at best, even if six or more of such anastomoses have been created. Other parameters of successful therapy such as a reduction in the incidence of cellulitis, increased softness of the limbs or improved quality of life have not been studied. Remarkably, the authors do not report any adverse effects of their surgical therapy; in fact, they do not evenmention the possibility of complications at all. Any surgical therapy has its down side and at least the theoretical possibility of making a condition worse warrants attention in any surgical paper. As many studies report