ABSTRACT
Lymphedema results as a consequence of a low-output failure of the lymph vascular system. This form of lymph vascular inadequacy arises, if some pathological process causes the transport capacity of the lymph vascular system—the highest possible lymph flow per unit of time—to decrease below the level of the normal lymphatic protein and water load. In the first clinical stage of lymphedema, designated as reversible by U. Brunner, the swelling is due to the accumulation of a protein-rich edema fluid. Due to a reduction of immune defense mechanisms in lymphedema, attacks of cellulitis in some patients occur several times a year. Diuretic treatment of lymphedema contradicts both the pathophysiology of lymphedema and the pharmacology of diuretics. From the pathophysiological point of view, surgery of lymphedema should either increase the lymphatic transport capacity and/or reduce the normal lymphatic load, in order to permanently achieve its goal of a definitely stabilized balance between the lymphatic load and the lymphatic transport capacity.
