Ruediger G.H. Baumeister Reconstructive Lymph Vascular Surgery 123 Reconstructive Lymph Vascular Surgery Ruediger G.H. Baumeister Reconstructive Lymph Vascular Surgery Ruediger G.H. Baumeister Division of Plastic-, Hand-, and Microsurgery Department of Surgery Ludwig Maximilians University Munich Germany ISBN 978-3-319-31645-1 ISBN 978-3-319-31647-5 (eBook) DOI 10.1007/978-3-319-31647-5 Library of Congress Control Number: 2016941934 © Springer International Publishing Switzerland 2017 T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland To my family Pref ace T he lymphatic vascular system is rarely considered as a fi eld of vascular surgery. Treatment of arteries and veins in open procedures are mostly performed with naked eyes. H owever, only with the help of operating microscopes and advanced microsurgical skills that it is possible to deal with lymphatic vessels, like dealing with other vessels in order to perform lymphatic anastomoses and lymphatic bypass procedures. The necessity to overcome local interruptions of a lymphatic pathway is clinically obvious when lymphedema is the result. Such a lymphatic obstacle may be the sequela of a trauma or a medical intervention, preferentially at regions where the lymphatic transporting system becomes narrow like in the axilla or in the groin area. Treatment of lymphedema is one of the topics in plastic surgery. There, using the operating microscope to deal with small arteries and veins is a prerequisite for many modern procedures. T hus, the author, who has a degree in vascular surgery and in plastic surgery as well, was infl uenced by both disciplines, in the search for a causal therapy for lymphedema caused by a local obstruction of the lymphatic system. Lymphatic vascular surgery is not restricted to the treatment lymphedema due to local obstacles; it is also important in the reconstruction of damaged lymphatic vessels which may result to lymphoceles or lymph fi stulas. T he book gives an overview of the fi eld of reconstructive vascular surgery, performed in our institution, from bench to bedside. It refl ects the pathophysiologic basis of this kind of treatment, shows the experimental basis, and gives hints for training of lymphatic vascular microsurgery. It delivers the ways of investigating the effects of the treatment and shows the results of treatment in patients. Finally, it refl ects possible interactions between lymphatic vascular surgery and other treatment options. The book is primarily addressed to vascular surgeons, plastic surgeons, and interested lymphologists. It might be helpful to perform lymphatic vascular surgery and to get informed about the possibilities of treating patients by that way. Munich, Germany Ruediger G. H. Baumeister vii Acknowledgments W orking for the development of a new strategy is never a one-man show. There are supporters who help one to get started, helpers working to establish and colleagues helping to carry on. The fi rst glimpse to the abdominal thoracic duct of a rat was contrived to me by Prof. Sun Lee from San Diego. At the very end of a microsurgical course in Berlin late at night, he asked: “Who is interested to deal with lymphatic vessels?” Only a few where. B ack in Munich, starting with lymph vascular microsurgery was essentially supported by the head of the Institute for Surgical Research, Prof. Walter Brendel. He was interested in the lymphatic system and had invented the “antilymphocytic serum” to minimize rejection in organ transplantation, a serum which was asked for by Prof. Barnard to treat his heart trans- plantation patients. In this institute, with the help of a grant, given by the VW foundation, experimental studies were carried out for several years. Valuable help was provided by Prof. J. Seifert from the Institute for Surgical Research, Prof. B. Wiebecke from the Institute of Pathology, and Prof. H. Liebich from the Veterinary Faculty. One person has to be mentioned specifi cally in this context: Mrs. Jutta Krumbach, a chemo- technician, who helped the young searcher not only during normal business hours but also during long night sessions, necessary for the long-lasting surgeries at the beginning. Performing the experimental studies besides the duties for the patients was only possible with the help of my teacher and mentor in plastic surgery, Prof. Heinz Bohmert. He also was interested in lymphedema after breast surgery and axillary dissection. He taught me the “Thompson procedure” for arm lymphedema. T he introduction of reconstructive lymph vascular surgery in the clinical fi eld was sup- ported by the head of the Department of Surgery, Prof. Georg Heberer. The fi rst lymphatic vessel transplantation was performed on June 23, 1980, at the Department of Surgery of the Ludwig Maximilian University of Munich, Campus Grosshadern. A series of candidates for the doctor’s degree worked on this project: Ch. Gabka, U. Goldmann, D. Saumweber, M. Kressel, and Stefanie Springer, to mention only some of them. A lso, foreign guest researchers contributed to experimental studies, like M. Kudla from Czech Republic, M. El-Shazly from Egypt, and S. Sepulveda from Chile. I ’d like to thank especially Prof. Andreas Frick, who supported the clinical work through all these years. He also worked experimentally together with Prof. Johannes Hoffmann on the implication of liposuction and lymphatic structures. P D. Dr. J. Wallmichrath contributed thereafter valuably to the scientifi c establishing of the lymphatic to lymph node approach. Colleagues at the Department of Nuclear Medicine like E. Kleinhans, D.Hahn, and M. Weiss contributed to the search for objectifying the results by nuclear medical methods. A t the Institute for Clinical Radiology, M. Notohamiprodjo was supporting MRI lymphog- raphy studies. T he contribution by Mrs. E. Hanesch for the drawings and by Mr. A. Steeger for the photo- graphic work is highly appreciated. I thank Springer Nature Publishing for the help in editing this book. ix