title: Lymphedema microsurgical preventive healing approach: a new technique for primary prevention of arm lymphedema after mastectomy.
abstract: BACKGROUND
  The purpose of this manuscript is to assess the efficacy of direct lymphatic venous microsurgery in the prevention of lymphedema following axillary dissection for breast cancer.
  
  
  METHODS
  Nineteen patients with operable breast cancer requiring an axillary dissection underwent surgery, carrying out LVA between the blue lymphatics and an axillary vein branch simultaneously. The follow-up after 6 and 12 months from the operation included circumferential measurements in all cases and lymphangioscintigraphy only in 18 patients out of 19 cases.
  
  
  RESULTS
  Blue nodes in relation to lymphatic arm drainage were identified in 18/19 patients. All blue nodes were resected and 2-4 main afferent lymphatics from the arm could be prepared and used for anastomoses. Lymphatic-venous anastomoses allowed to prevent lymphedema in all cases. Lymphangioscintigraphy demonstrated the patency of microvascular anastomoses.
  
  
  CONCLUSIONS
  Disruption of the blue nodes and closure of arm lymphatics can explain the significantly high risk of lymphedema after axillary dissection. LVA proved to be a safe procedure for patients in order to prevent arm lymphedema.
authors.affiliation: Department of Surgery, Unit of Lymphatic Surgery, S. Martino Hospital, University of Genoa, 16132 Genoa, Italy. francesco.boccardo@unige.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Boccardo
authors.forename: Federico
authors.initials: F
authors.lastname: Casabona
authors.forename: Franco
authors.initials: F
authors.lastname: De Cian
authors.forename: Daniele
authors.initials: D
authors.lastname: Friedman
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Villa
authors.forename: Stefano
authors.initials: S
authors.lastname: Bogliolo
authors.forename: Simone
authors.initials: S
authors.lastname: Ferrero
authors.forename: Federica
authors.initials: F
authors.lastname: Murelli
authors.forename: Corradino
authors.initials: C
authors.lastname: Campisi
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D008408:Mastectomy / Q000009:adverse effects*; D008866:Microsurgery; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011877:Radionuclide Imaging; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome