Editorial

Dear colleagues,

the newest issue of the journal of plastic surgery Acta Chirurgie Plasticae lies before you. A large part of it is devoted to the problem of lymphatic insufficiency, both from a historical and from a contemporary perspective.

In our country, conservative care for patients with lymphatic insufficiency is advanced, if they reach lymphology cen­ters. Patients should learn systematic, regular and long-term to lifelong care of their limbs there. It should also become the rule to consult a surgical centre that deals with lymphatic surgery. By this I mean that conservative everyday care can be suitably supplemented, especially by lymphovenovenous anastomoses. Although we performed them 30 years ago, the biggest boom has come up in the last 10 years. In particular, Asian countries are establishing centers where these procedures are performed on patients daily with annual numbers of 500 or more anastomoses. Asians prefer to sew on small subcutaneous veins, and at our institution, we are now looking again at the great subcutaneous vein, especially the great saphnenous vein v. and cephalic vein. The reason is our belief that the larger the recipient vein is, the lower the blood pressure is in it and therefore the greater the likelihood of lymphatic drainage, which may not be regular, but intermittent. Then, too, one must soberly assess the success of such treatment. I believe that a loss of a few cm in circumference or even the fact that the lymphedema has stopped growing and is maintained unchanged by the necessary conservative therapy is sufficient for success in our country. I am convinced that most Asian patients who come for lymphovenous anastomoses do not have conservative care prior to surgery. A greater effect is seen after surgery with regular massage of the limb.

I am also convinced that it is only a matter of a few years before the lymphology and plastic surgery societies find a common algorithm for the care of their clients’ lymphatic insufficiency so that they will not overwork their patients, but will work together for the general benefit. I wish them the best in this endeavor.

Prof. Jiří Veselý, MD, CSc.
Department of Plastic and Aesthetic Surgery, Faculty of Medicine of Masaryk University, and St. Anne’s University Hospital, Brno, Czech Republic