Microsurgery for lymphedema: clinical research and long-term results.
OBJECTIVE
To report the wide clinical experience and the research studies in the microsurgical treatment of peripheral lymphedema.


METHODS
More than 1800 patients with peripheral lymphedema have been treated with microsurgical techniques. Derivative lymphatic microvascular procedures recognize today its most exemplary application in multiple lymphatic-venous anastomoses (LVA). In case of associated venous disease reconstructive lymphatic microsurgery techniques have been developed. Objective assessment was undertaken by water volumetry and lymphoscintigraphy.


RESULTS
Subjective improvement was noted in 87% of patients. Objectively, volume changes showed a significant improvement in 83%, with an average reduction of 67% of the excess volume. Of those patients followed-up, 85% have been able to discontinue the use of conservative measures, with an average follow-up of more than 10 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery.


CONCLUSIONS
Microsurgical LVA have a place in the treatment of peripheral lymphedema, and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment.
Campisi
Corradino
C
Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San Martino Hospital, University of Genoa, Italy. campisicorradino@tin.it
Bellini
Carlo
C
Campisi
Corrado
C
Accogli
Susanna
S
Bonioli
Eugenio
E
Boccardo
Francesco
F
D000714:Anastomosis, Surgical; D035843:Biomedical Research; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D008209:Lymphedema / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D011877:Radionuclide Imaging; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013995:Time; D016896:Treatment Outcome