Breast cancer-related lymphedema (LE) represents an important morbidity that jeopardizes breast cancer patients' quality of life. Different attempts to prevent LE brought about improvements in the incidence of the pathology but LE still represents a frequent occurrence in breast cancer survivors. Over 4 years ago, Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) was proposed and long-term results are reported in this study. From July 2008 to December 2012, 74 patients underwent axillary nodal dissection for breast cancer treatment together with LYMPHA procedure. Volumetry was performed preoperatively in all patients and after 1, 3, 6, 12 months, and once a year. Lymphoscintigraphy was performed in 45 patients preoperatively and in 30 also postoperatively after at least over 1 year. Seventy one patients had no sign of LE, and volumetry was coincident to preoperative condition. In three patients, LE occurred after 8-12 months postoperatively. Lymphoscintigraphy showed the patency of lymphatic-venous anastomoses at 1-4 years after operation. LYMPHA technique represents a successful surgical procedure for primary prevention of arm LE in breast cancer patients.

The LYMPHA technique appears to be feasible, safe, and effective for the prevention of lower limb lymphedema, thereby improving the patient's quality of life and decreasing health care costs.

Groin lymphocele (GL) is a frequent complication of inguinal lymph node dissection, and conservative treatment is not always successful. Different surgical methods have been used to treat lymphoceles arising from lymphatics injured during groin surgery. However, they all involve the closure of lymphatics merging at the lymphocele, increasing the risk of postoperative lower limb lymphedema or of worsening lymphedema if already clinically evident. We assessed the efficacy of a diagnostic and therapeutic protocol to manage inguinal lymphoceles using lymphoscintigraphy (LS) and microsurgical procedures. Sixteen GL [seven associated with leg lymphedema (LL)] were studied by LS preoperatively and treated by complete excision of lymphocele and microsurgical lymphatic-venous anastomoses between afferent lymphatics and a collateral branch of great saphenous vein. Lower limb lymphatics were identified intraoperatively using Patent Blue dye injection. Nine patients without lymphedema had complete healing of lymphocele and no appearance of lower limb postoperative lymphedema. The other seven patients with associated secondary lymphedema had complete disappearance of lymphocele and a remarkable reduction of leg volume. Four of them completely recovered without the need of any compression garment, after the first year postoperative. Inguinal lymphocele nonresponsive to conservative treatment can be advantageously studied by LS and successfully treated by microsurgical reconstructive procedures, above all if associated to LL.

The problem of prevention of lymphatic complications in surgery is extremely important if we think about the frequency of both early complications such as lymphorrhea, lymphocele, wound dehiscence and infections and late complications such as lymphangitis and lymphedema. Nowadays, it is possible to identify risk patients and prevent these lesions or treat them at an early stage. This report helps to demonstrate how it is important to integrate diagnostic and clinical findings to better understand how to properly identify risk patients for lymphatic injuries and, therefore, when it is useful and proper to do prevention. Authors report their experiences in the prevention and treatment of lymphatic injuries after surgical operations and trauma. After an accurate diagnostic approach, prevention is based on different technical procedures among which microsurgical procedures. It is very important to follow-up the patient not only clinically but also by lymphoscintigraphy. A protocol of prevention of secondary limb lymphedema was proposed and it includes, from the diagnostic point of view, lymphoscintigraphy and, as concerns therapy, it recognizes also a role to early microsurgery. It is necessary to accurately follow-up the patient who has undergone an operation at risk for the appearance of lymphatic complications and, even better, to assess clinically and by lymphoscintigraphy the patient before surgical operation.