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Thromboangiitis obliterans (TAO).

Whilst many problems affecting the vascular system may be managed by vascular surgical procedures or alterna- tively by minimally invasive catheter-directed interven- tions, the treatment of vascular injury and definitive care thereof are unquestionably the unchallenged fiefdom and responsibility of the well-trained vascular surgeon,whose clinical and diagnostic acumen,expediency and opera- tive skill are in demand.

According to the World Health Organization and to the International Working Group on the Diabetic Foot [32], diabetic foot is defined as the foot of diabetic pa- tients with ulceration, infection and/or destruction of the deep tissues, associated with neurological abnor- malities and various degrees of peripheral vascular disease in the lower limb.

The main goal of all vascular surgeons in the field of arterial iseases or trauma in the extremities is in order to save vitality and function. However, despite substantial improvement of limb-salvage rates in patients with peripheral vascular disease, extremity amputation can be, in some cases, the only possible treatment for a limb severely affected by trauma, infection, tumour, or at the last stage of ischaemia [8].

The lymphatic system is a significant pathway for the drainage of fluid,large protein molecules and white blood cells from the interstitial spaces within capillary beds. Lymphatic capillaries lie in the dermis and subcu- taneous fat, in the fascial planes between muscles and in perivascular tissues. Lymphatic vessels transport lymph from these areas through regional lymph nodes towards the thoracic duct. Lymph returns to the venous circula- tion via the termination of the thoracic duct at the left internal jugular vein close to its junction with the left subclavian vein. The system plays a major immunologi- cal role,with the regional lymph nodes processing anti- gens presented to them by white blood cells from the pe- ripheries. Antigen-specific lymphocytes proliferate in the lymph nodes and are then released into the circulation via the main lymph ducts and also through small lym- phovenous connections within the lymph nodes them- selves. Impaired drainage of lymph from a limb, usually due to obstruction of the system, leads to the accumu- lation of fluid and protein in the subcutaneous tissues with eventual irreversible fibrosis and swelling, known as lymphoedema [8].