# Lymphedema Surgical Treatment Using BioBridgeTM: A Preliminary Experience
## 4 Discussion  
Microsurgery of LE consisting of venolymphatic anastomoses and vascularized lymphnode transfer has improved the management of LE patients. In the past, several scaffolds have been applied to help lymphedema patients regain their lymphatic function. In 1908, [PERSON] suggested utilizing synthetic lymphatic conduits made of sterile silk sutures [25]. He demonstrated how the subcutaneous implantation of these silk threads into the afflicted limbs assisted lymphatic fluid drainage by capillary action. Although the silk threads had a positive initial effect, they ultimately led to foreign-body reactions that restricted lymphatic fluid drainage shortly after implantation and caused other problems, such as infection. Later, a comparable strategy was started using wicking Teflon multifilament material rather than silk [26], with a partial benefit. Even while these findings were insufficient to be applied therapeutically as a feasible treatment option, they did support [PERSON]'s hypothesis that the creation of an artificial lymphatic conduit could lead to rapid alleviation of LE. Interstitial flow has been linked to the growth of new lymphatic capillaries, according to recent research [27]. The development of lymphatic capillaries that flow in the same direction as the directional interstitial flow occurs first. The BioBridgeTM scaffold might really work by promoting capillary flow, which would make it possible to simultaneously relieve edema and create the ideal environment for lymphangiogenesis. Endothelial cells can thrive in the environment provided by BioBridgeTM. Our results support the potential application of BioBridgeTM in lymphatic function regeneration. Using non-contrast MR lymphography, we provided both clinical and imag  
Figure 10: Preoperative non-contrast MR lymphography (based on high-resolution heavily T2-weighted coronal sequences (turbo spin echo with repetition time 2870 ms, echo time 797 ms, field of view 380 \(\times\) 380 mm, matrix 358 \(\times\) 384, slice thickness 1 mm) (**a**) and follow-up non-contrast MR lymphography (**b**) 1-year post-venolymphatic-anastomosis. Marked edema involving the lower third of the leg, the ankle, and the dorsum of the foot (blue arrows) is visible in (**a**), while follow-up imaging (**b**) shows a reduction of the edema (blue arrows), but without evidence of any new lymphatic vessels. ing evidence showing a decrease in the volume of the affected anatomical areas, as well as new lymphatic collectors. Initial studies by [PERSON] et al. [17] and [PERSON] et al. [28] provided inferential support for the hypothesis that the addition of collagen scaffolds to autologous lymphnode transfer would provide the necessary support to improve micro-lymphatic vascular engraftment and repair, similarly to its effect on arteriogenesis, through its favorable effect on lymphatic endothelial biology in the repair response. Chronic scarring is also a known pathologic element of lymphedema in its later stages. In a study by [PERSON] et al., it was discovered that fibril alignment lowers excessive fibroblast proliferation, which in turn minimizes scar formation [29]. This finding may have clinical implications for lymphedema models. In a porcine model of acquired lymphedema, [PERSON] et al. [30] demonstrated that the implantation of BioBridgeTM aided in the restoration of lymphatic drainage. In the period of observation following BioBridgeTM implantation, the lymphatic tissue was repaired, resulting in restored lymphatic system functionality and reduced fluid stagnation related to the disease. When compared to the surrounding irradiated tissue or to untreated irradiated tissue, immunohistochemical microscopy showed a higher number of lymphatic collectors in the vicinity of the implanted collagen scaffold in all treatment groups. Although there were more blood vessels here as well, the ratio of lymphatic to blood vessels close to the scaffold altered in favor of lymphatics.