Obstructive Lymphedema of Lower Limbs Can Be Successfully Controlled by Silicone Tube Implants Replacing Obliterated Lymphatic Collectors
Background: Lymphedema of limbs is caused by partial or total obstruction of lymphatic collectors. In advanced cases all main lymphatics are obstructed and tissue fluid accumulates in the interstitial spaces. The microsurgical lympho-venous shunts cannot be performed. We propose in such cases drainage of fluid accumulations by creating artificial flow pathways to the non-obstructed regions by implantation of silicone tubes.
Aim: To present the 3 to over 6 year follow up results of therapy by subcutaneous implantation of silicone tubes.
Methods: In 150 patients with obstructive limb lymphedema after pelvic or axillary lymphadenectomy and irradiation in uterine or breast cancer or following soft tissue inflammation silicone tubes were implanted subcutaneously.
Results: There was a) immediate decrease of limb circumference within days after implantation b) in lower limbs there was in a 3 years follow up a decrease in mid-calf circumference by a mean -8.7% (P<.05) with range of -3.2% to -31.0 % corresponding to 90-900ml volume and in the mid-thigh a mean –1,8% (P<.05) with range of -9.3% to + 3% equal to 0-900ml. In the upper limb in the two-year follow up the decrease in the mid-forearm was -8.5% (P<.01) with a range of -3.0% to -22.0 % and in the mid-arm a mean –12% (P<.05) with a range of -7% to - 22%. That corresponded to 180-700ml volume for the limb. c) decrease in tissue stiffness, d) maintenance of tubes patency on control lymphoscintigraphy, contrast opacification and ultrasonography, d) lack of reaction to foreign body and effective control of inflammation at the site of implantation using low doses of benzathine penicillin.
Conclusions: The technical simplicity of the surgical procedure, fast decrease of limb edema and lack of tissue reaction to the implant make the method worth applying in advanced stages of lymphedema.