Prevention of lymphatic injuries in surgery.
BACKGROUND
The problem of prevention of lymphatic injuries 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 lymphangites and lymphedema. Nowadays, it is possible to identify risk patients and prevent these lesions or treat them at an early stage. This article 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.


METHODS
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.


CONCLUSIONS
It was identified a protocol of prevention of secondary limb lymphedema that included, from the diagnostic point of view, lymphoscintigraphy and, as concerns therapy, it also recognized 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.
Francesco
Boccardo
B
Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San Martino Hospital, University of Genoa, Italy. francesco.boccardo@unige.it
Corrado
Campisi
C
Giuseppe
Murdaca
M
Emanuela
Benatti
B
Chiara
Boccardo
B
Francesco
Puppo
P
Corradino
Campisi
C
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000517:prevention & control*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008208:Lymphatic System / Q000601:surgery*; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000293:injuries*; D008220:Lymphography; D061305:Lymphoscintigraphy; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D011322:Primary Prevention / Q000379:methods; D011877:Radionuclide Imaging / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome