Microsurgery for treatment of peripheral lymphedema: long-term outcome and future perspectives.

Authors report over 30 years of their own clinical experience in the treatment of chronic peripheral lymphedemas by microsurgical techniques performed at the Center of Lymphatic Surgery of the University of Genoa, Italy. Over 1,500 lymphedema patients were treated with microsurgical techniques. Derivative lymphatic-venous techniques were most often used. For those cases where a venous disease was associated to lymphedema, reconstructive lymphatic microsurgery techniques were performed (lymphatic-venous-lymphatic-plasty). Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Volume changes showed a significant improvement in over 83%, with an average follow-up of more than 10 years. There was an 87% reduction in the incidence of cellulitic attacks after microsurgery. Microsurgical lymphatic-venous anastomoses have a place in the treatment of peripheral lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonoperative treatment. Improved results can be expected with operations performed at earlier lymphedema stages.

The lymphatics in the pathophysiology of thoracic and abdominal surgical pathology: immunological consequences and the unexpected role of microsurgery.

The authors report their experience in the diagnosis and treatment of lymphatic and chylous disorders in the thoracic and abdominal areas. Sixteen patients (10 adults, 6 children) affected by primary chylous ascites with associated syndromes and consequent immunological incompetence were studied. Diagnostic investigations included abdominal sonography scans, lymphoscintigraphy, and lymphography combined with computed tomography and laparoscopy. Surgical treatment included laparoscopy, drainage of ascites and/or the chylothorax, treatment of abdominal and retroperitoneal chylous leaks, exeresis of lymphodysplastic tissues, ligation of incompetent lymph vessels also by CO(2) LASER, and chylo-venous and lympho-venous microsurgical shunts. Eleven patients did not have a relapse of the ascites and four patients had a persistence of a small quantity of ascites with no protein imbalance. All patients had an improvement of their immunocompetence. Median follow-up was 5 years. We demonstrated that the use of microsurgery is remarkably advantageous for performing a causal treatment of the dysfunction.

[Prevention of lymphoedema secondary to the treatment of breast cancer: a case report and proposal for a prevention protocol]. / La prevenzione del linfedema secondario al trattamento del tumore della mammella: dal caso clinico ad una proposta di protocollo di prevenzione.

Secondary lymphoedema of the upper limbs is a fairly frequent complication of breast cancer treatment. It is related to dissection of the axillary lymph nodes, and manifests itself in the form of clinically important lymphostasis, particularly when the dissection is combined with radiotherapy. Despite the fact that the surgical treatment of mammary cancer has become more conservative and, at the same time, radiotheraphy (when necessary) now proves less aggressive and more efficacious, secondary lymphoedema is still reported with incidence rates ranging from 5 to 25%, with an increase of up to 35% and more, when dissection of the axillary lymph nodes is followed by radiotherapy. The aim of this study was to highlight the essential importance of an early diagnosis of secondary lymphoedema, above all in relation to the prevention of this pathology. We report the case of a patient who, at the same time as the axillary lymphnode dissection, underwent a microsurgical operation consisting in the construction of lymphatic-venous shunts in the arm as a preventive measure, because lymphoscintigraphy of the upper limbs, carried out in advance, had revealed a predisposition to the development of lymphedema.

Peripheral lymphedema: new advances in microsurgical treatment and long-term outcome.

We report on the modern surgical management of peripheral lymphedema. An adequate diagnostic route is essential: it has to include patient history and clinical examination, an isotopic lymphography, an accurate study of the venous circulation, and in cases of angiodysplasia, an accurate study of the artery circulation. Based on over 25 years of clinical experience (more than 1,000 patients), the role of derivative and (in those cases where a venous disease is associated with lymphostatic pathology) reconstructive lymphatic microsurgery is particularly underlined, in comparison with conservative medico-physical treatment, to which it is complementary. "Debulking" surgery can be used just in properly selected patients for minor operations with only cosmethic-reductive purposes. With a follow-up even over 15 years after surgery, positive results from lymphatic microsurgery can be achieved in more than 80% of cases, especially in patients at precocious stages.