Peripheral lymphedema: New advances in microsurgical treatment and long‐term outcome

Abstract

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.

Long-Term Results of Microscopic Lymphatic Vessel-Isolated Vein Anastomosis for Secondary Lymphedema of the Lower Extremities

“…11,16,17 This may be because we performed surgery on very selected patients whose lymphedema had proven intractable to nonoperative management, while excluding patients with very early stage lymphedema. However, we did not exclude any patients from the indication criteria because of the pattern of lymph drainage seen on preoperative lymphoscintigraphy.…”

“…11,16,17 Of the 447 patients followed up for longer than 7 years, significant volume reduction was achieved: in fact, 380 (85%) were able to discontinue conservative measures, with an average reduction of 69% of the excess limb, and an 87% reduction in the incidence of cellulitis after microsurgery. However, they did not document in detail the preoperative nonoperative treatments their patients received.…”

“…7-10 However, as many as 30%-40% of patients suffer from intractable lymphedema unresponsive to conservative treatment no matter how correctly it is applied by expert teams of lymphangiologists and physiotherapists. 11 Operative treatments have not been accepted worldwide, since they often require combined physiotherapy after the procedure to maintain a reduction in the edema. 3 Moreover, the long-term efficacy of surgical treatment has not yet been evaluated sufficiently and prospective clinical trials have not been performed.…”

Lower extremity lymphedema

“…Unfortunately, problems with wound healing are prevalent and create short-and long-term obstacles. 2,29,30 Drug therapy Drug therapy has been disappointing in the management of lymphedema. Family physicians often prescribe diuretics, but when studied, they have not been found to be helpful in lymphedema.…”

In VitroInduction of Human Adipose-Derived Stem Cells into Lymphatic Endothelial-Like Cells

“…Despite numerous efforts, no effective treatment has emerged (Campisi and Boccardo, 2002;Felmerer, 2012;Vignes and Trévidic, 2002). Many studies support the idea that reconstruction of the lymphatic circulation is an ideal treatment of lymphedema (Boccardo et al, 2013;Campisi et al, 2003). However, the challenge of promoting lymphatic endothelial proliferation or transformation has not yet been addressed.…”