الفهرس 
ANATOMY AND EMBRYOLOGY OF LYMPHATIC SYSTEMOnly 14 pages are availabe for public view
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Abstract
Lymphedema is an accumulation of fluid containing proteins and other elements in the tissue spaces due to an imbalance between interstitial fluid production and transport .It arises from congenital malformation of the lymphatic system or from damage to the lymphatic vessels and/or lymph nodes.
There are two types of lymphedema, primary and secondary. Primary lymphedema results from abnormalities or malformation of the lymphatic vessels and or lymph nodes. Primary lymphedema can occur at any age and is usually only confirmed once all possible causes of lymphedema have been ruled out. Secondary lymphedema is caused by damage to the lymphatic system resulting in functional deficiency .The most common form of secondary lymphedema is caused by filarial infection transmitted by the mosquito. Other key causative factors include, trauma and tissue damage, infection, malignancy, venous disease, inflammation and immobility.
In the majority of patients, the diagnosis of lymphedema can be made by history and physical examination, excluding alternate causes of edema such as cardiac, renal, hepatic and venous disease.
This disease is often first noticed by the patients as an asymmetry or increased circumference of an extremity. As swelling slowly progresses,patients may have difficulty fitting into clothing. In true lymphedema,swelling generally begins distally and progresses proximally over months to years.
The edema is initially soft and pits easily. It gradually becomes nonpitting as fibrosis develops and the tissue becomes indurated. Skin changes may occur, but ulceration is infrequent. Patients may complain of fatigue or pressure in the extremity, but pain is infrequent.
Lymphedema can be investigated by lymphangiography,lymphoscintography, doppler ultrasonography, computed tomography (CT) scans and magnetic resonance imaging (MRI).
Lymphedema is an incurable chronic condition, which is progressive if left untreated. Early diagnosis and treatment are therefore essential to prevent physical and psychological morbidity.
Conservative Management: include:
Skin care ,elevation ,compression garment,pneumatic pump,complex decongestive therapy.
Pharmacological Treatment: (Prevention and treatment of infection)
Surgical Treatment:
Surgical intervention should be also considered if medical therapy is ineffective in controlling lymphedema or preventing complications.Although numerous surgical procedures for the treatment of lymphedema have been described, none is completely curative. Patients must understand that surgery does not obviate continued medical therapy Surgical techniques aim to diminish the size of the affected extremity, with resultant improvement in appearance, function, and prevention of infection. These procedures may be classified as ”excisional” or ”physiologic”. Physiologic operations attempt to re-establish lymphatic drainage, whereas excisional procedures debulk the limb by removing skin and subcutaneous tissue,some procedures may have both physiologic and excisional components.
Microsurgery has proved to be highly beneficial, especially in the early stages. Microsurgery techniques play an important role in lymphedema prevention, as well as in preventing disease progress and complications.
Two methods have been identified for ”conservative and functional”surgical treatment of lymphedema. Today they are commonly grouped under the two terms ”derivative microsurgery’ and ”reconstructive microsurgery”.
Finally,surgical techniques for correcting lymphedema may be excisional or physiological. However, surgery for lymphedema does not cure the disease or eliminate the need for decongestive treatment. Surgical treatment is used only in extreme cases in order to reduce the weight of the affected limb, to help minimize the frequency of inflammatory attacks, to improve cosmesis, and to potentially reduce the risk of secondary angiosarcoma.