Die lymphatische Chirurgie als Teil des orthoplastischen Konzepts- ein Übersichtsartikel

Zusammenfassung

Die Entwicklung eines sekundären Lymphödems stellt eine relevante und klinisch häufig beobachtete Komplikation nach chirurgischen Eingriffen oder Traumen dar. Ein Hauptproblem ist jedoch die meist ausbleibende oder sehr späte Diagnosestellung, sodass es in vielen Fällen nicht ausreichend behandelt wird. Darüber hinaus sind präzise epidemiologische Daten zur genauen Erhebung dieses Krankheitsbildes bisher noch sehr rar. Eine zu späte oder ausbleibende Behandlung dieser Erkrankung führt jedoch in der Regel zu einer weiteren Verschlechterung der Symptomatik und befördert einen chronischen Verlauf. Dies unterstreicht die Bedeutung einer frühzeitigen und präzisen Diagnose, um die richtigen therapeutischen Maßnahmen zu ergreifen und langfristige Komplikationen zu vermeiden. Der Artikel gibt einen Überblick über die Pathophysiologie des Lymphsystems, beschreibt die Entstehungsmechanismen des posttraumatischen Lymphödems und beleuchtet die Rolle von Infektionen. Darüber hinaus werden die relvantesten Klassifikationssysteme – klinisch, bildgebend nach Yamamoto – dargestellt. Zudem werden aktuelle konservative und operative Therapieoptionen erläutert. Ein interdisziplinäres Management unter Nutzung moderner mikrochirurgischer Techniken kann die Prognose der Betroffenen deutlich verbessern.

Abstract

The development of secondary lymphoedema is a relevant and frequently observed complication following surgical procedures or trauma. However, one of the main problems is that it is usually not diagnosed or diagnosed very late, resulting in inadequate treatment in many cases. In addition, precise epidemiological data on the incidence of secondary lymphoedema remains scarce. However, delayed or inadequate treatment of secondary lymphoedema usually leads to symptom progression and promotes a chronic course. This underlines the importance of early and accurate diagnosis to guide therapeutic measures and prevent long-term complications. This article provides an overview of the pathophysiology of the lymphatic system, describes the mechanisms underlying the development of post-traumatic lymphoedema, and highlights the role of infections. In addition, it presents the most relevant classification systems, including clinical and imaging-based systems such as Yamamoto’s. Current conservative and surgical treatment options are also explained. Interdisciplinary management with modern microsurgical techniques can significantly improve patient prognosis.

Schlüsselwörter

Fraktur - Pathologie - Infektion - komplexe Verletzung - Mikorchirurgie der Lymphgefäße - Mikrochirurgie

Keywords

fracture - pathology - infection - complex injury - microsurgery of lymphatics - microsurgery

Publication History

Received: 07 May 2025

Accepted: 27 September 2025

Article published online:
30 October 2025

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