A comprehensive review of the natural lymphaticovenous communications and their role in lymphedema surgery

Abstract

Cancer-related lymphedema is a progressive, chronic condition that impairs quality of life. Its pathophysiology and the mechanisms of action of current reconstructive surgical treatments are not fully understood but lymphaticovenous communications may play a key role. We review the available literature on lymphaticovenous communications and their implications in lymphedema surgery, and propose a subclassification of lymphaticovenous communications. J. Surg. Oncol. 2016;113:374-380. © 2016 Wiley Periodicals, Inc.

The surgical anatomy of the supraclavicular lymph node flap: A basis for the free vascularized lymph node transfer

“…Apart from conservative treatment, which mainly consists of physiotherapy and the application of compression garments, vascularized lymph node transfer is performed as an effective surgical method for lymphedema reduction . The basic mechanism of this procedure is to bypass the damaged lymphatic vessels by transferring a lymph node flap to the affected extremity, directly draining lymph fluid to the venous system . Effects on a cellular and molecular level are yet to be further investigated.…”

Post‐traumatic lymphedema treatment with superficial circumflex iliac artery perforator lymphatic free flap: A case report

“…The significant improvement 14 days after surgery despite lymphatic regeneration can be explained by the existence of intra‐tissular lymphovenous communications, which have been previously proposed as a contributing factor for the success of LN transfer. It would be the equivalent to “choke vessels” between the lymphatic and venous systems, in tissue rich in lymphatic vessels (Miranda Garcés, Mirapeix, Pons, Sadri, & Masià, ; Miranda Garcés, Pons, Mirapeix, & Masià, ). These communications would explain lymphedema improvement in the early postoperative period, before the lymphatic system has been properly restored through inosculation and/or lymphangiogenesis, taking the excess of lymph from the peripheral tissue and facilitating its passage into the venous circulation within the flap.…”

Intratissue lymphovenous communications in the mechanism of action of vascularized lymph node transfer

“…They would open minutes after the disruption of the lymphatic system allowing the transport of lymph to blood (Fig. ) . Therefore, the clinical improvement reported in patients with lymphedema treated with VLNF would not only depend on the function of lymph nodes.…”

“…Venous pressure is essential in LVC functioning. Experimental studies show that high venous pressure in the lymph node leads to fibrosis and prevents opening of LVC within the lymph nodes . High venous pressure may also avoid intratissue LVC opening.…”