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

While I welcome an upturn in clinician interest in the lymphatic system, I still see accounts of lymphatic/ interstitial fluid circulation that ignore the absorption of fluid into lymph node venules. I have previously pointed to the work of Dr Corinne Becker at the Lymphoedema Centre,. 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. Now we have a substantial meta-analysis of 31 studies involving 581 patients confirming that vascularised lymph node transfer (VLNT) is effective in reducing excess limb volume and cellulitis episodes in both upper and lower limb lymphoedema after cancer treatment. An interesting confirmation of the steady-state Starling principle.

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