Invited Commentary

Invited Commentary Dr. Dorffler-Melly and co-authors have been working on physiology of those fine vascular structures are of out­ lymphatic microcirculation for many years. Several other most importance in the treatment of this desease. authors Calnan [1], Casley-Smith [2-4] and FOldi [5] Although not all details of the paper of Dr. Dorffler­ were concerned with the propulsion, pressure and flow Melly are completely new, they show a good way to be of lymphcollectors in animals as well as in humans. They followed for the judgement of therapy in lymphedema. mostly looked for an effective therapy of lymphedema. 1977, 1979 and 1981 Olszewski [8, 9] published his papers reguarding lymph transportation, flow and pres­ References sure in the leg of healty humans. I. Calnan JS, Pflug JJ, Reis ND, Taylor LM (1968) Lymphatic The method of measurement of the lymph capillary pressure and the flow of lymph. Br J Plast Surg:305-317 pressure combined with the visualisation of the superficial 2. Casley-Smith JR, Bolton T (1972) The presence of large effec­ microlymphatic used now in this paper is already known tive colloidal osmotic pressure across large pores. Mircovasc and has been published a few years ago by the same au­ Res 5:213-216 3. Casley-Smith JR, FOldi-Borsok E, FOldi M (1979) A fine struc­ thors. tural study of the tissue channels numbers and dimension in nor­ 1982 and 1983 the co-authors of this paper Bollinger mal and lymphedematous tissue. Lymphologie (J Lymphol) and Franzeck [6, 7] have published their results about flu­ 3:49-58 orescence microlymphography by lymphedema and ve­ 4. Casley-Smith JR (1980) The fine structure and functioning of nous congestion. tissue channels and lymphatics. Lymphology 12:177-183 5. Foldi M (1977) Physiology and pathophysiology of lymph flow. In physiological conditions the lymphatic pressure of In: Clodius L (ed) Lymphedema. Thieme, Stuttgart, pp 1-11 the collectors is well regulated having higher or lower 6. Isenring G, Franzeck VK, Bollinger A (1982) Fluoreszenz­ peaks but remaining grossly constant within the 24 h. Mikroangiographie am medialen Malleolus bei gesunden Patien­ The results of Dr. Dorffler-Melly and co-authors now ten und Patienten mit primiirem Lymphodem. Schweiz Med Wochenschr 112:225-231 show that lymphatic capillaries also have a constant gra­ 7. Jager K, Isenring G, Bollinger A (1983) Fluorescence microlym­ dient during the day with less pronounced waves. phography in patients with lymphedema and chronic venous in­ Under pathological conditions, as in primary and sec­ competence. Int Angio 2:129-135 ondary lymphedema, capillary hypertension occurs al­ 8. Olszewski WL (1977) Collection and physiological measure­ ment of peripheral lymph and interstitial fluid in man. Lymphol­ most doubling the physiological pression (from ogy 10:137-142 7.9+3.4 mmHg to 15.0+5.1 mmHg). The measurement 9. Olszewski WL, Engeset A (1979) Intrinsic contractility of leg of the LCP in the 24 h time and after 7 weeks of interval lymphatics in man. Lymphology 12:81-84 by Dr. Dorffler-Melly are useful for comparing the same data to them in pathological conditions. G. Ingianni Since lymphedema is more a disease of interstitium and Ferdinand-Sauerbruch-Klinikum, Elberfeld, Arrenberger Strasse 20 capillaries than of main collectors, physiology and patho- D-42117 Wuppertal, Germany European Journal of Plastic Surgery Springer Journals

Invited Commentary

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Copyright © 1998 by Springer-Verlag Berlin Heidelberg
Medicine & Public Health; Plastic Surgery
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