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Phlebologie 2021; 50(02): 141-146
DOI: 10.1055/a-1375-6891
Schwerpunktthema

Mikrochirurgische Therapieoptionen beim Lymphödem

Microsurgical Procedures for Lymphedema
Ines E. Tinhofer
1   Plastische und Rekonstruktive Chirurgie, Abteilung für Chirurgie, Göttlicher-Heiland-Krankenhaus
,
Johannes Steinbacher
1   Plastische und Rekonstruktive Chirurgie, Abteilung für Chirurgie, Göttlicher-Heiland-Krankenhaus
,
Chieh-Han J. Tzou
1   Plastische und Rekonstruktive Chirurgie, Abteilung für Chirurgie, Göttlicher-Heiland-Krankenhaus
2   TZOU MEDICAL, Lymphödemzentrum Wien
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Zusammenfassung

Das Lymphödem ist eine multifaktorielle Erkrankung, die durch Ödem, interstitielle Fibrose und, im späteren Verlauf, durch Fettgewebsablagerungen charakterisiert ist. Das klinische Erscheinungsbild variiert je nach Stadium und geht mit unterschiedlich großen physischen, psychologischen und sozioökonomischen Einschränkungen einher.

Ein Lymphödem kann sowohl primär aufgrund genetisch bedingter abnormer Entwicklungsabläufe auftreten als auch sekundär als Folge von Trauma, Bestrahlung oder Infektion. Die Unterscheidung in primäres und sekundäres Lymphödem gibt dabei neben der Ursache auch Rückschlüsse über die zu erwartenden Erfolgsaussichten einer mikrochirurgischen Intervention.

In der plastischen und rekonstruktiven Chirurgie kann durch zweierlei Verfahren eine Verbesserung des Krankheitsbildes erzielt werden. Einerseits durch ablative Verfahren, wie beispielsweise die Liposuktion oder Resektion von überschüssigem Gewebe, und andererseits durch physiologische, mikro- und supermikrochirurgische Techniken zur Wiederherstellung des Lymphabtransportes, wie beispielsweise die vaskularisierte Lymphknotentransplantation („vascularized lymph node transfer“, VLNT) und die Anlage lymphovenöser Anastomosen (LVA).

Abstract

Lymphedema is a multifactorial disease, characterized by swelling, fibrosis and fat deposition. Depending on its grading, it is associated with a varying degree of physical, psychological and socioeconomical burden. Lymphedema can either occur primarily due to developmental abnormalities or secondarily due to trauma, radiation or infection. The differentiation according to its entity further allows to draw conclusions about the potential effects of microsurgical interventions. In plastic and reconstructive surgery, lymphedema can be treated either through ablative procedures like liposuction and resection, or through microsurgical- and supermicrosurgical procedures like lymphovenous anastomoses and vascularized lymph node transfer.

Schlüsselwörter

Lymphödemchirurgie - Mikrochirurgie - lymphovenöse Anastomose - Lymphknotentransfer

Key words

lymphedema surgery - microsurgery - lymphovenous anastomosis - lymph node transfer


Publication History

Article published online:
18 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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