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CC BY 4.0 · Arch Plast Surg
DOI: 10.1055/a-2513-4313
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A Proposed Role for Lymphatic Supermicrosurgery in the Management of Alzheimer's Disease: A Primer for Reconstructive Microsurgeons

Joon Pio Hong 
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Seoul, Korea
,
Wei F. Chen 
2   Cleveland Clinic, Center for Lymphedema Research and Reconstruction, Cleveland, Ohio
,
Dung H. Nguyen 
3   Stanford Women's Cancer Center, Palo Alto, California
,
Qingping Xie 
4   Qiushi Hospital Hangzhou, Hangzhou, People's Republic of China
› Author Affiliations Funding MMI – Medical Microinstruments, Inc. provided funds for professional medical writing assistance.
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Abstract

The relatively recent discovery of a novel lymphatic system within the brain meninges has spurred interest in how waste products generated by neurons and glial cells—including proteins associated with Alzheimer's disease (AD) pathology such as amyloid beta (Aβ) and tau—are disposed of. Evidence is building that suggests disease progression in AD and other cognitive impairments could be explained by dysfunction in the brain's lymphatic system or obstruction of drainage. An interesting implication of this hypothesis is that, by relieving the obstruction of flow, lymphatic reconstruction along the drainage pathway could serve as a potential novel treatment. Should this concept prove true, it could represent a surgical solution to a problem for which only medical solutions have thus far been considered. This study is meant to serve as a primer for reconstructive microsurgeons, introducing the topic and current hypotheses about the potential role of lymphatic drainage in AD. A preview of current research evaluating the feasibility of lymphatic reconstruction as a surgical approach to improving Aβ clearance is provided, with the aim of inspiring others to design robust preclinical and clinical investigations into this intriguing hypothesis.

Keywords

Alzheimer's disease - glymphatic system - meningeal lymphatic system - intramural periarterial drainage - lymphatic reconstruction - lymphovenous anastomosis - supermicrosurgery

Author Contributions

Conceptualization, investigation, supervision, and writing—original draft, review, and editing—were done by J.P.H. Conceptualization and writing—review and editing—were done by W.C., D.N., and Q.X.


Ethical Approval

Not applicable to this review article.




Publication History

Received: 24 December 2024

Accepted: 03 January 2025

Accepted Manuscript online:
10 January 2025

Article published online:
30 January 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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