In Memoriam Prof. Prof. h.c. Dr. med. Michael Földi, January 10, 1920 - October 20, 2018 "Father of Lymphology".

In Memoriam: With deep sadness the world of Lymphology learned of the death of Prof. Prof. h.c. Dr. med. Michael Földi, a ground breaking pioneer of modern Lymphology. Words alone will never fully describe or capture the breadth and depth of Michael's contribution to our lymphatic knowledge and the legacy he has left for us all.

Missteps when mice with lymphatically insufficient tails leap from molecular biology to human clinical lymphology.

A cautionary note is provided about making translational leaps from molecular biology and murine lymphedema models to clinical lymphology.

Psycholymphology: why not all patients with chronic lymphedema want therapy.

This Commentary provides the reader with various motivations and psychologic factors patients have for refusing as well as for accepting long-term therapy of lymphedema.

Histologic investigation of vascular malformations of the face after transarterial embolization with ethibloc and other agents.

Twenty-one vascular malformations located in the facial area, 11 high-flow arteriovenous malformations and 10 slow-flow malformations, underwent combined treatment by embolization and later surgery. Embolization was performed simultaneously with superselective angiography of the branches of the external carotid artery. The new biodegradable fibrosing agent Ethibloc was used in 16 cases. Histologic examination of the surgical specimens confirmed the good target orientation by the transarterial injection of Ethibloc. Limitations of this technique are discussed. The agent proved to have thrombogenic and fibrogenic properties. Some of the vascular walls degenerated and ruptured following the embolization, but there were no instances of necrosis of interstitial tissue or skin. Embolization treatment of vascular malformations of the face was not curative, but it facilitated subsequent surgery in all examined cases.

Xeroradiography examinations in orbitonasal surgery. Preliminary report.

The use of xeroradiography for graphic visualization of both the bony and soft tissue structures of the head is presented. The advantages and indications are discussed.

Minimizing secondary arm lymphedema from axillary dissection.

Regional complications after axillary lymphadenectomy are common and usually involve perioperative skin dehiscence, wound infection, and seroma formation and later arm lymphedema. Gentle handling of tissues during operation, and routine use of closed catheter suction drainage with direct external axillary compression with immobilization of the shoulder after nodal dissection are advocated to minimize both the early and late sequelae. Healing by primary intent is facilitated and the opportunity for reconnection of divided lymphatics (lymphangiogenesis and lymphvasculogenesis) are thereby optimized.

The use of a tissue tonometer as a diagnostic aid in extremity lymphoedema: a determination of its conservative treatment with benzo-pyrones.

With the aid of a tissue tonometer, we have been able to gain an estimate of the rate at which the lymphoedematous tissue loses its compressability and regains it upon treatment with the non-steroidal anti-inflammatory drugs: the benzo-pyrones. The values obtained by tonometry, unlike other objective methods of measurement of the effectiveness of a therapy, approximate closely to the patients subjective claims.

A new instrument for the evaluation fo tissue tonicity in lymphoedema.

An instrument which measures the resistance of the tissues to compression has been used to assess the effectiveness of a therapy for long term lymphoedema. In this preliminary study, all cases of long standing lymphodema showed an increased resistance of the affected tissue to compression. Following an average of 30 months' Venalot treatment the resistance of the fibrotic tissues was restored to normal levels. It is believed that this way of assessing the state of the tissues and the value of therapy is a more accurate representation of the actual situation and should be used in preference to measurement of the circumference or plethysmography.

The problems of lymphatic microsurgery for lymphedema.

The problems of microsurgery for lymphedema consist of the discrepancy between the excellent technical possibilities, especially of microsurgical lympho-venous shunts and the subsequently insufficient reduction of the lymphedematous tissue fibrosis and sclerosis. Generally, the lymphatic surgeon considers the lymphatic system to be a canalicular system of drainage tubes, of lymph collectors. Bypassing a lymph block through peripheral lympho-venous shunts should therefore solve the problem of lymphstasis, present in each type of lymphedema. In chronic lymphedema however, not only the canalicular lymphatic system, but also the tissues, and integral part of the lymphatic system, are affected. In chronic lymphedema, canalicular repair, for reasons of quantitative lymph drainage, exceptionally only provides a "restitutio ad integrum" of the tissues, altered by lymph stasis.

Tissue changes in chronic experimental lymphoedema in dogs.

Chronic lymphoedema was experimentally induced in the legs of dogs and studied with the electron microscope, including by quantitation. It was found that some cells (macrophages, fibroblasts and, to a lesser extent, lymphocytes) increased greatly in numbers and relative volumes. Collagen (and fat cells) also greatly increased in relative volume. The lengths of blood vessels and initial lymphatics were much greater in the injured tissue. The numbers of small vesicles and vacuoles rose greatly in both types of vessels. Both also had many open endothelial junctions--although no doubt from different causes. It is probably caused by excessive accumulations of proteins, so chronic lymphoedema is probably a form of chronic inflammation.

[A new use for the freely transplanted omentum. Management of a late radiation injury of the brachial plexus using freely transplanted omentum and neurolysis]. / Eine neue Anwendung des frei transplantierten Omentums. Behandlung des Strahlenspätschadens des Armplexus mit frei transplantiertem Netz und Neurolyse.

A short review of the structural characteristics and the function of the greater omentum is presented. The results of treatment of secondary lymphedema by free transplantation of the omentum with microvascular anastomoses in the canine model and their relevance for clinical application are discussed. Clinical indications, operative technique, and results of omental transplantation and exoneurolysis of the brachial plexus in seven patients with constrictive, radiation induced brachial plexus paralysis, with and without secondary lymphedema, are reviewed. No effect of the grafted omentum on arm-lymphedema was observed over the entire observation period of 1 1/2--4 years. Minor degree reversion of neurodegenerative changes was found in two patients, in all other patients, these changes stopped. The most impressing result was the immediate and permanent disappearance of pain in all patients.

[Problems of microsurgery in lymphedema]. / Die Problematik der Mikrochirurgie bei Lymphödemen.

Microsurgery for primary and secondary lymphedema at present consists of shunts between lymphatic vessels and veins. The surgical technique has been well established for more than a decade. The problems consist of the irreversible changes in the peripheral lymphatic system and in the connective tissues, as well as the obliteration of the deep lymphatics, best suited for lymphaticovenous anastomoses. These changes are recognized only late, after clinical swelling becomes manifest. Therefore, lymphaticovenous shunts should be performed prophylactically. Their number should be sufficiently high to solve the quantitative problem, caused by the reduced lymphatic transport capacity.

Revascularization of a free nerve graft wrapped in omentum.

The revascularization of free nerve grafts wrapped in omentum was assessed in an experimental model using rats. Revascularization of the grafts, using the original vessels, proceeded in the same way as reported in earlier studies, being in progress on the 4th day after the operation and essentially complete on the 8th day. The observations made in the experiment suggest that using omentum does not offer much of an advantage with nerve grafts transplanted to tissues with a good blood supply. Using omentum would seem indicated for grafts transplanted into cicatrized or irradiated tissues.