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A Journal on Phlebology

Official Journal of the Italian College of Phlebology
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Acta Phlebologica 2000 September;1(1):23-31

language: English

Role of veins in lymphatic microsurgery

Campisi C., Boccardo F., Napoli F., Zilli A., Macciò A.

Department of Specialistic Surgical Sciences, Emergency Surgery Unit, Lymphology and Microsurgery Center, S. Martino Hospital, Genova, Italy, University of Genova, Italy


BACKGROUND: The use of Microsurgery to ­treat periph­er­al lym­phed­e­mas ­requires an accu­rate ­study of par­tic­u­lar and impor­tant hae­mod­y­nam­ic ­aspects in ­order to ­obtain suc­cess­ful and ­long-­term ­results. Apart ­from lym­phat­ic cir­cu­la­to­ry inves­ti­ga­tion, the ­study ­includes the eval­u­a­tion ­above all of ­venous ­system in the ­same lym­phe­dem­a­tous ­limb.
METHODS: The selec­tion of can­di­date ­patients for Lymphatic Microsurgery ­includes iso­top­ic lym­phog­ra­phy and an accu­rate ­study of the ­venous cir­cu­la­tion, ­besides, if ­required (panan­gio­dys­pla­sias), of the ­arterial cir­cu­la­tion. Over 25 ­years clin­i­cal expe­ri­ence (1197 operations) is report­ed and the ­role of Derivative and Reconstructive Lymphatic Microsurgery is par­tic­u­lar­ly under­lined. Derivative Lymphatic Microsurgery was rep­re­sent­ed ­above all by mul­ti­ple lym­phat­ic-­venous anas­to­mos­es. And, for ­those cas­es ­where a ­venous dis­ease was asso­ciat­ed to lym­phos­tat­ic pathol­o­gy, Reconstructive Lymphatic Microsur-gery tech­niques ­were real­ized: lym­phat­ic-­venous-lym­phat­ic-plas­ty. For prop­er out­come meas­ures ­water vol­u­met­ric stud­ies and lym­phos­cin­ti­graph­ic pat­terns are essen­tial.
RESULTS: With a fol­low-up at 1, 3, 6, 12 ­months and ­once a ­year at ­least for the ­first 5 ­years ­after sur­gery, and in ­about 30% of the ­patients ­also at ­over 10-15 ­years, pos­i­tive ­results ­from Lymphatic Microsurgery can be ­achieved in the great majority of ­patients, ­with better evi­dence ­among ­patients at ­stage II or III. The ­role ­played by stan­dard­ized lym­phan­gios­cin­tig­ra­phy ­proved to be essen­tial to dem­on­strate the effi­ca­cy of deriv­a­tive and recon­struc­tive micro­sur­gi­cal anas­to­mos­es.
CONCLUSIONS: Long ­term clin­i­cal out­come of lym­phat­ic micro­sur­gery ­leads to the con­sid­er­a­tion ­that ­today lym­phat­ic micro­sur­gery can be advan­ta­geous­ly ­used for the treat­ment of periph­er­al lym­phed­e­mas, but it is nec­es­sary to fol­low ­exact indi­ca­tions for ­each ­case, on the ­base ­above all of the con­di­tions of ­venous cir­cu­la­tion ­from ­both flow­met­ric and man­o­met­ric ­points of ­view.

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