The Pathophysiology of Lymphedema – 2012

Abstract

Lymphedema of the limbs has become a frequent pathological condition after soft tissue inflammation, trauma, removal of lymph nodes in cancer and long-lasting ulcerations. Lymphatics draining the diseased tissues become occluded. Microsurgery helps in the formation of anastomoses and collaterals bypassing the obstruction site. Surgeons operating on the lymphatics should be aware of the tissue fluid/lymph formation mechanism, hydraulics of tissue fluid/lymph, tissue metabolism and waste material utilization, immune function in terms of elimination of microbial and tumor antigens and raising tolerance to own tissue antigens of injured tissues necessary for wound healing as well as classification of diseases of lymphatics. In this review we present the actual definition of the lymphatic system, how it is changed in lymphedema, and, in particular, tissue fluid/lymph biochemistry, pressure and flow, histopathology and tissue fluid location, and finally how to manage the most common complication dermato-lymphangioadenitis. Detailed knowledge of the anatomy of upper limb limphaties should prevent their damage and loss of function.

Zusammenfassung

Das Lymphödem der Gliedmaßen ist eine häufige Komplikation nach Weichteilentzündung, Trauma oder onkologischer Lymphknotendissektion sowie chronischer Ulzeration. Es kommt hierbei zu einer Funktionsstörung der die betreffende Region drainierenden Lymphbahnen. Durch mikrochirurgische Eingriffe können Anastomosen sowie Bypässe zur Überbrückung beschädigter Lymphbahnabschnitte angelegt werden. Die Chirurgie beim Lymphödem erfordert die Berücksichtigung des Entstehungsmechanismus von Lymph- bzw. Gewebeflüssigkeit und deren Strömungsverhalten, des Gewebestoffwechsels, der Wiederverwertung von Gewebeabfallprodukten, des Immunsystems in Hinblick auf Elimi­nierung mikrobieller und tumoreigener Antigene sowie Erzeugung von Immuntoleranz gegenüber körpereigenen Antigenen auch bei verletzten Strukturen mit Unterstützung der Wundheilung als auch der Klassifikation von Lympherkrankungen. In dieser Übersichtsarbeit präsentieren wir die aktuelle Definition des Lymphsystems, seine Veränderung beim Lymphödem, insbesondere die Biochemie der Gewebeflüssigkeit bzw. Lymphe, Druck- und Flussverhältnisse im Lymphbahnsystem, die Gewebepathologie und Lokalisierung der Flüssigkeit und zuletzt die Behandlungsempfehlung der häufigsten Komplikation beim Lymphödem, der Dermato-Lymphangioadenitis.

Key words

lymphedema - lymphatics - lymph nodes - lymph - tissue fluid

Schlüsselwörter

Lymphödem - Lymphbahnen - Lymphknoten - Lymphe - Gewebeflüssigkeit

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