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Italian Journal of Vascular and Endovascular Surgery 2021 March;28(1):25-41

DOI: 10.23736/S1824-4777.21.01495-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Matching primary with secondary lymphedemas across lymphatic surgery in Genoa (Italy) from 1973 until time of COVID-19

Corradino CAMPISI 1 , Marlys WITTE 2, Caterina S. CAMPISI 3, Lidia MOLINARI 4, Ezio FULCHERI 5, Giuseppe VILLA 6, Samir G. SUKKAR 7, Giovanni DE CARO 8, Umberto ROSSI 9, Francesco PETROCELLI 10, Mara TACCHELLA 11, Roberto MARENCO 12, Roberto RISSO 13, Arianna DEMORO 14, Corrado C. CAMPISI 15, 16

1 School of Medical Sciences, and Pharmaceutics, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; 2 Unit of Surgery, Neurosurgery and Pediatrics, University of Arizona, Tucson, AZ, USA; 3 Private Clinic, Consultant Dermatologist, Genoa, Italy; 4 Private Clinic, Consultant General and Alimentary Tract Surgeon, Genoa, Italy; 5 School of Medical Sciences and Pharmaceutics, Unit of Anatomo-Histopathology, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; 6 Department of Nuclear Medicine, IRCCS San Martino University Hospital, Genoa, Italy; 7 Operative Unit of Clinical Nutrition and Dietetics, IRCCS San Martino University Hospital, Genoa, Italy; 8 Department of Radiology, Villa Montallegro Clinic, Genoa, Italy; 9 School of Medical Sciences and Pharmaceutics, Unit of Interventional Radiology, Department of Radiological Area, Galliera Hospital, University of Genoa, Genoa, Italy; 10 Department of Radiology and Interventional Radiology, IRCCS San Martino University Hospital, Genoa, Italy; 11 Department of General Surgery, Galliera Hospital, Genoa, Italy; 12 Surgical Nursing Private Consultant, Genoa, Italy; 13 Physio-Massotherapist Private Consultant, Genoa, Italy; 14 Podiatric Rehabilitation Private Consultant, Genoa, Italy; 15 Reconstructive and Aesthetic Surgery, University of Catania, Catania, Italy; 16 Plastic, Reconstructive and Aesthetic Surgery, Department of Lymphatic Surgery, Private Consultant, Genoa, Italy



Authors report their pluridecennial activity (from 1973 up to today) of research, clinical experience and development of lymphatic surgery in Genoa-Italy, in close collaboration with the worldwide centers of the International Society of Lymphology. Five thousand forty-six cases of patients affected by upper and/or lower limbs, primary and secondary lymphedemas and elephantiasis, between 1973 and 2020 underwent lymphatic microsurgery; and between 2012 and 2020, fibro-lipo-lymph-aspiration, according to lymph vessel sparing procedure (FLLA-LVSP), for latest stages of lymphedema/elephantiasis, previously treated by lymphatic microsurgery with partial improvement of the disease. In addition, also morbid obesity related elephantiasis, lipolymphedema/elephantiasis, chylous-lymphatic dysplastic gravitational reflux with complex related syndromes, were treated by tailored surgical procedures, properly combined with tailored medical and nutritional regimens. All patients were followed-up for a minimum of 5 years to over 20 years. Over 96% of patients with earlier stages of disease (initial lymphedema: stage IB and increasing lymphedema: stage IIA) progressively stopped using conservative therapies; and over 80% of patients with later stages (column shaped limb fibrolymphedema: stage IIB, properly called elephantiasis: stage IIIA, and extreme elephantiasis: stage IIIB), significantly decreased the frequency of physical therapies and discontinued compressive garments or stockings. Dermato-lymphangio-adenitis attacks considerably reduced by over 95%. Staging-guided treatment of peripheral lymphedema, according to authors’ Genoa protocol, carries out not only the best long-lasting treatment, but also the contextual target of primary (to avoid lymphatic injuries), secondary (early-stage treatment), and tertiary (late-stage treatment) prevention in the potential worsening of the disease.


KEY WORDS: Lymphedema; Elephantiasis; Lymphoscintigraphy; Magnetic resonance imaging; Microsurgery; Prevention and control

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