The authors discuss the role of surgery to manage primary and secondary lymphoedema in patients whose lymphoedema has not been controlled by standard conservative measures and whose symptoms are worsening. There is a brief discussion of the relevant investigations and techniques applicable to lymphovascular anastamosis (LVA). The variation in surgical approach according to stage, severity and anatomical location are highlighted. The authors discuss the results of the series of patients. The numbers of patients and the percentage reduction as measured by volumetry are presented in graphical form, and are very difficult to interpret. More impressively, the authors also state that 85% of patients with early stage (1B and 2A) lymphoedema can eventually dispense with conservative measures, whilst the more severe cases show less improvement. The incidence of infective complications of lymphoedema is also shown to be reduced. This paper overall highlights the effectiveness of microsurgery in the management of lymphoedema and contributes to the growing body of evidence to support this procedure. It is, however, weakened by poor reporting of patient numbers and results. 

Lymphatic microsurgery to treat lymphoedema. Techniques and indications for better results.
Bocardo F, Fulcheri E, Villa G, et al.
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Mark Butterworth

St John's Hospital, Livingston, UK.

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