[Choice of abdominoplasty method depending on abdomen form].

Comparative study of treatment results of abdominoplasty various method depending on abdomen form at 82 patients demonstrates advantages of tense-lateral type over other methods. This type of abdominoplasty was performed at 32 cases including 14 patients with pear-shaped form of abdomen and 18 patients with dome-shaped form. There were no complications. All the complications have occurred after classical abdominoplasty.

[Morphological changes in femoral vein wall structure in presence of persistent vertical reflux].

The article contains an analysis of different mechanisms of persistent chronic venous insufficiency formation and its impact on the condition of lower extremity magistral vein wall. The authors studied autopsy samples of femoral vein segments from 86 patients aged 56 to 64 years, who had died of non-cardiovascular diseases. The investigation revealed significant changes in the vein wall structure, associated with persistent overload caused by valvular insufficiency and continuous persistent vertical reflux. At the same time, valve cusp structure remodels. Histological studies show that the overload of the system of deep femoral vein segment primarily increases the bulk of longitudinal smooth muscle cells, which fulfill the main contractile function in contrast to circular smooth muscle cells, performing the tonic function. Further overload of all vein wall structures results in structural alterations, smooth muscle cell hypertrophy, forming of longitudinal smooth muscle cell fascicle, and finally, their dystrophic changes. These processes bring about clinical presentations of chronic venous insufficiency.

[Pathogenesis and treatment strategies for lymphorrhea and lymphocele after vascular surgeries on the lower extremities]. / Patogenez i taktika lecheniia limforei i limfotsele posle sosudistykh operatsii na nizhnikh konechnostiakh.

From 1995 to 2003 lymphatic complications (lymphorrhea and lymphocele) after different vascular surgeries on the lower extremities were seen in 57 (4.6%) patients. All the methods of therapeutic and surgical treatment of lymphorrhea and lymphocele are presented. Problems of surgical policy and some aspects of pathogenesis of these complications are regarded. Ethiopathogenetic classification of lymphatic complications is proposed. Creation of lymphovenous anastomosis is regarded as the most promising method. This surgery was performed in 31 patients, efficacy was 96.8%. The method permits one to stop inflow of lymph into lymphatic cavity and to avoid lymphedema after surgery. Other methods of treatment have various efficacy.

Lymphedema of the extremities: prospects of microsurgical treatment.

Presented herein is an experience with the treatment of 60 patients with lymphedema of the extremities, who had undergone transplantation of "lymphatic flaps". The treatment success is analyzed in both free microsurgical autotransplantation of tissue complexes (52 patients) containing intact lymphatic structures and in transposition (8 patients). The authors evaluate the potential of radio-nuclide diagnostic techniques for quantification of the effectiveness of surgical treatment. After transplantation and transposition of different types of "lymphatic flaps" good results were obtained in 36 (60%) patients. The prospects of the use of "lymphatic flaps" are assessed from the standpoint of the current concepts related to the surgical treatment of lymphedema of the extremities.

Evaluation of the greater omentum in the treatment of experimental lymphedema.

Despite advances in microsurgery, the most suitable operation for primary lymphedema remains unclear. A variety of tissue transplants and artificial substances have been used to facilitate drainage of peripheral lymph. The greater omentum, for example, has absorptive lymph draining capability, fights infection, and is expendable for the abdomen. Previous attempts to use the omentum in treatment of clinical lymphedema have, however, been disappointing. This discrepancy between theory and outcome prompted us to reevaluate the role of the omentum in the treatment of chronic lymphedema. In rabbits, mobilization of omentum was carefully examined by three separate techniques and the presence of natural lymph nodal-venous (L-V) shunts determined by an injection of Evans blue into the omentum with sampling later of plasma from the gastroepiploic venous blood. In dogs after promotion of unilateral chronic hindlimb lymphedema by soft tissue excision and sclerosis, the results of four methods of omental transplantation with or without L-V shunt for relief of lymphedema were compared. The results in rabbits suggest that although the greater omentum can be lengthened without jeopardizing its blood supply, it is inappropriate to lengthen it based on blood vascular arcades alone because the omental lymphatics do not strictly follow these arcades in the more distal portion, and with elongation, may be interrupted even though the blood supply remains intact. Moreover, because there is no natural L-V shunt within the greater omentum, the addition of a L-V shunt in dogs in addition to omental transplantation seems to increase effectiveness of the omentum for draining hindlimb lymph after its autotransplantation.

Autotransplantation of the greater omentum in the treatment of chronic lymphedema.

We evaluated the use of transplantation of the greater omentum in the management of chronic lymphedema in 21 patients. The omentum provides a large surface with fluid absorbing capability and potentially therefore is useful in management of patients with primary or hypoplastic peripheral lymphatics. Based on the angio- and lymphangio-architecture of the gastroepiploic architecture, we used large segments of greater omentum as a free autotransplant with microrevascularization to the femoral or axillary artery and vein thereby avoiding technical drawbacks of a pedicle graft with the feeding vessels traversing the abdomen. Elongation of the omentum must be done properly because omental lymphatic arcades do not consistently follow the blood vascular arcades in its more distal part. Accordingly, if not properly mobilized the blood supply may be retained whereas the lymph circulation is interrupted. We combined omental implantation with lymph nodal-venous anastomoses using an omental vein with a nearby systemic venous tributary. In 19 of the 21 patients followed from 3 months to 2 years after operation, remission of lymphedema was good (reduction in swelling more than 50%) in 14 patients and satisfactory in 5 (approximately 25-50% reduction in swelling) with improvement gradually increasing with the passage of time.

Enteromesenteric bridge in the treatment o primary lymphedema--a case report.

Technical details and associated problems of enteromesenteric bridging operation for primary lymphedema (proximal obstructive hypoplasia) are discussed. The short term results are encouraging.

[Endolymphatic pressure in the evaluation of the status of peripheral lymph flow in the extremities]. / Endolimfaticheskoe davlenie v otsenke sostoianiia perifericheskogo limfotoka v konechnostiakh.

The functional capacity of the lymph vessels in their various pathological conditions was determined from 78 studies of the endolymphatic pressure in patients with lymphatic edema of the extremities. Four types of pressure curves were determined according to the maintenance of the contractility of the wall of the lymph vessels. It was found that marked hypertension develops in the lymphatic channel in obstruction of lymph drainage from the extremity. Endolymphatic pressure in hyperplasia of the lymph vessels and blocking of lymph drainage exceeds venous pressure several times, which confirms the competence of operation for the formation of direct lymph-vein anastomoses.

[Changes in the lymphatic vessels of the upper extremity following a radical mastectomy (based on lymphographic data)]. / Izmeneniia limfaticheskikh sosudov verkhnei konechnosti posle radikal'noi mastéktomii (po dannym limfografii).

The study group included 171 patients suffering from postmastectomy syndrome which had developed either after combined treatment for breast cancer or after radical mastectomy alone. Lymphographic examination of 146 cases carried out long after treatment for primary treatment revealed frequent roentgenologic features characteristic of all patterns of secondary obstructive lymphatic edema. In 20 patients, lymphographically-detectable changes were followed at early stages (until day 40 after radical mastectomy) before edema became clinically apparent. Radiation therapy and erysipelatous inflammation were shown to have an effect on lymphatic lesions.

Reconstructive microsurgery in treatment of lymphoedema in extremities.

A total of 510 cases of primary and secondary lymphoedema in upper and lower extremities have been examined with two thirds of primary lymphoedema cases among them. Radical mastectomy combined with irradiation has led to the development of obstructive lymphoedema of upper limbs in most patients. 230 patients with primary and secondary lymphoedema have been subjected to microlymphatic surgery and lymphaticovenous anastomoses have been carried out with microsurgical techniques. Limb volume measurement, the results of direct lymphangiography and intralymphatic pressure reading were taken into account to select patients suitable for microlymphatic surgery. Most favourable results have been obtained in secondary obstructive lymphoedema cases (total 81.2%) due to well-marked hypertension in lymphatic vessels that contributes to better functioning of the lymphaticovenous anastomoses made in a patient.

[Correction of lymph flow disturbance following radical mastectomy]. / Korrektsiia narusheniia limfotoka posle radikal'noi mastéktomii.

Results of operations for the lympho-venous anastomosis in 50 patients were analyzed. The operation was shown to correct the lymph flow in patients with secondary lymphatic edemas of upper extremities. Good results were obtained in 15 patients, satisfactory results in 28 patients. More careful selection of the patients, improvement of the operation technique are the ways to get better results of the operation.