Lymphoedema microsurgery: are we re-inventing the wheel yet again?

Microsurgery as a treatment for lymphoedema is not new. Indeed, the late Bernard O’Brien first described the suite of surgical techniques that are used today in 1976,1 the year of this author’s birth! Nevertheless, despite extraordinary growth in the number of publications relating to lymphovascular anastomoses and free lymph node transfer, it is still important to ask ourselves how far we have actually come in the past four decades and whether, in this latest burst of enthusiasm, we are merely re-inventing the wheel. Apart from an interesting technical exercise in which microsurgeons challenges themselves to anastomose smaller and smaller vessels, how realistic is it to expect these tiny vessels to drain a whole limb?