Page 6 - Read Online

Grünherz et al. Plast Aesthet Res 2023;10:20 Plastic and
DOI: 10.20517/2347-9264.2023.24
Aesthetic Research

Review Open Access

Central lymphatic surgery

Lisanne Grünherz, Nicole Lindenblatt
Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich 8091, Switzerland.
Correspondence to: Prof. Dr. Nicole Lindenblatt, Department of Plastic Surgery and Hand Surgery, University Hospital Zurich,
Rämistrasse 100, Zurich 8091, Switzerland. E-mail: nicole.lindenblatt@usz.ch

How to cite this article: Grünherz L, Lindenblatt N. Central lymphatic surgery. Plast Aesthet Res 2023;10:20.
https://dx.doi.org/10.20517/2347-9264.2023.24

Received: 2 March 2023 Start Revision: 4 April 2023 Revised: 15 April 2023 Accepted: 28 Apr 2023 Published: 9 May 2023

Academic Editor: Melissa B. Aldrich Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
In recent years, microsurgical reconstruction of the lymphatic system has opened new frontiers in the treatment of
central lymphatic lesions. Central lymphatic lesions can be congenital or acquired. While the latter can result from
any surgery or trauma in the area of the thoracic duct, congenital lymphatic lesions can show a plethora of
manifestations, ranging from singular thoracic duct abnormalities to complex multifocal malformations. Regardless
of the anatomical location of the thoracic duct lesion, these conditions cause recurrent chylous effusions and
downstream lymphatic congestion and are associated with increased mortality due to the permanent loss of
protein and fluid. In case of disruption of the lymphatic flow, microsurgical reconstructive surgery is indicated to
treat downstream congestion leading to bronchitis plastica, protein-loosing enteropathy, chylothorax, and
chylascites. Thoracic duct-vein anastomoses can reconstruct the physiological lymphatic flow.

Keywords: Central conducting lymphatic anomaly, thoracic duct lesion, lympho-venous anastomosis, thoracic
duct, central lymphatic lesion

INTRODUCTION
Central lymphatic lesions may arise in the course of trauma and surgery or be congenital. The latter are
classified as primary lymphatic anomalies, which can show very different manifestations, ranging from
singular thoracic duct lesions to complex multifocal malformations. The overall prevalence of primary
lymphatic anomalies, including lymphatic malformations as well as primary lymphoedema, is 1:4,000
[1,2]
live births, with some patients not developing symptoms until adulthood .

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

www.parjournal.net