Scrotal elephantiasis can be physically disabling and psychologically distressing to the victim. Ablative procedure has been used in its treatment and has achieved limited success. The authors developed a microlymphaticovenous procedure to treat elephantiasis of the scrotum and applied it clinically in three patients. The immediate and long-term (13-24 months) results have been very satisfactory. The scrotum size was dramatically reduced to a nearly normal level, and subjective symptoms and objective signs were improved. The operative techniques are described, the three case histories are illustrated, and the advantages of microlymphaticovenous anastomosis, the selection of patients, and the factors required for success of the surgery are discussed.

Thirteen patients with secondary obstructive lymphedema of the upper and lower extremities were treated by microlymphaticovenous anastomosis. The immediate and long-term results have been very satisfactory. An average reduction in the circumference of the affected limb of 6.2 cm was obtained, and subjective symptoms and objective signs were improved. No correlation was established between the quality of the results and the duration of the lymphedema or the number of anastomoses employed in treating it. On the basis of microlymphaticovenous surgery for lymphedema of the extremities, the authors also developed a microlymphaticovenous procedure to treat lymphedema of the external genitalia and applied it clinically in two patients. Good results were obtained in both instances. The operative techniques and four case histories are described, and the advantages of microlymphaticovenous anastomosis, the selection of patients, and the facts required for success of the surgery are discussed.

On the basis of microlymphaticovenous anastomosis for treating lymphedema of the extremities, the authors developed a microlymphaticovenous procedure to treat congenital lymphedema of the breast and applied it clinically in two patients. The immediate results have been fairly good. The breast and its nipple had been reduced in size and to a nearly normal level. The results are maintained after a half year of follow-up. The fundamentals and techniques of the operation are described and the two case histories are reported. The cases presented here appear to be the first successful clinical attempts to treat lymphedema of the breast by microlymphaticovenous anastomosis. The clinical character of congenital lymphedema, the indication of the microlymphaticovenous anastomosis, and the factors required for success of microlymphatic surgery are discussed.

The findings from dissections, injection studies, and angiograms of 180 specimens of the anterior portion of left and right iliac crests taken from 90 cadavers are reported. These findings suggested that the deep circumflex iliac vessels were suitable for use as a nutritive pedicle in microvascular free transfer of iliac bone. Therefore, the technique of microvascular free transfer of iliac bone based on these vessels was developed and applied clinically in 2 cases with good results. The advantages and disadvantages of using the superficial circumflex iliac vessels or the deep circumflex iliac vessels as the vascular pedicle for iliac grafts also are discussed.

A simple, inexpensive method for producing an experimental model for lymphedema in rabbit ear is described. In 47 of 50 rabbit ears, the lymphedema could be demonstrated by measurement of ear thickness, water displacement, skin thickness, diameter of lymphatics, and histopathology of the experimental ear. Three rabbit ears failed because of technical reasons. In studying the findings of experimental lymphedema, some clinical phenomena are explained and modifications of the operative procedure of microlymphaticovenous anastomosis for treating lymphedema are suggested.