Lymph nodes reabsorb lymphatic fluid; a surgical application of an important principle.

I was surprised to learn of the work of Dr Corinne Becker at the Lymphoedema Centre, and with a little searching discovered that many surgeons are now offering autologous lymph node transplant for the treatment of lymphoedema. Students of the steady state Starling principle will understand the rationale; contrary to standard medical school physiology teaching, there is no significant reabsorption of fluid filtered to the tissues by venous capillaries and venules. Indeed, the very existence of lymphoedema following proximal lymph node ablation or excision stands as confirmation of the physiology. Transplanted lymph nodes would have to secure a blood supply and connections with afferent lymphatics in order to work, so it is to be expected that results take many months or more to materialise if the operation is successful. The results that I have seen published are therefore a remarkable testament to Dr Becker’s skill. As well as an interesting confirmation of the steady-state Starling principle.

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