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International Angiology 1999 March;18(1):47-51


lingua: Inglese

Role of microsurgery in the management of lymphoedema

Campisi C., Boccardo F.

From the Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplantation (DISCAT) Section of Emergency Surgical Clinic - Lymphangiology and Microsurgery Center University of Genoa, San Martino Hospital, Genoa, Italy


Background. Microsurgical tech­niques in the treat­ment of periph­er­al lym­phoed­e­ma ­proved to be very prom­is­ing, the authors’ clin­i­cal expe­ri­ence with deriv­a­tive and recon­struc­tive lym­phat­ic micro­sur­gi­cal oper­a­tions was ana­lysed.
Methods. From 1973 to 1997, 843 ­patients were stud­ied and treat­ed by micro­sur­gi­cal meth­ods, with aver­age fol­low-up of over 5 years. Microsurgical tech­niques most­ly con­sist­ed of deriv­a­tive lym­phat­ic-­venous or lym­phat­ic-cap­sule-­venous anas­to­mos­es and recon­struc­tive autol­o­gous vein inter­posi­tioned ­grafts (lym­phat­ic-­venous-lym­phat­ic-plas­ty). Ninety per­cent of ­patients were oper­at­ed on at the II-III stage, 3% at the I and 7% at the IV-V stage. Limb vol­umes were meas­ured using the water dis­place­ment tech­nique and lym­phos­cin­tig­ra­phy was used to accu­rate­ly ­assess the struc­tu­ral and func­tion­al stat­us of the lym­phat­ic drain­age ­before and after var­i­able dis­tances of time after microsurgery. More recent­ly, also lym­phan­gio-MR was used to accu­rate­ly eval­u­ate chang­es in the lym­phoe­dem­a­tous extrem­ity ­before and after treat­ment.
Results. Postoperatively, all the ­patients had a reduc­tion of oedema var­i­able above all accord­ing to the stage of the pathol­o­gy at the time of micro­sur­gi­cal oper­a­tion. Short and long-term ­results were pos­i­tive, as con­cerns both vol­u­met­ric oedema reduc­tion and arm func­tion, ­besides the regres­sion of annu­al inci­dence of acute lym­phan­gites. The effi­ca­cy of micro­sur­gi­cal lym­phat­ic oper­a­tions has been ver­i­fied, more­over, by lym­phos­cin­tig­ra­phy.
Conclusions. Microsurgical tech­niques per­mit, today, the solution of com­plex clin­i­cal pat­terns not only of sec­on­dary but also of pri­mary, uni­lat­er­al and bilat­er­al, lym­phoed­e­mas, at dif­fer­ent stag­es, with bet­ter ­results the more pre­co­cious the micro­sur­gi­cal treat­ment is, with sta­bil­iza­tion of the ­result also at long dis­tance of time from oper­a­tion.

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