title: Lymphatic microsurgery to treat lymphedema: techniques and indications for better results.
abstract: This study aimed to report new clinical approaches to the treatment of lymphatic disorders by microsurgical techniques based on histological and immunohistochemical findings. The authors' wide clinical experience in the treatment of patients with peripheral lymphedema by microsurgical techniques is reported. Microsurgical methods included derivative lymphatic-venous anastomoses and lymphatic reconstruction by interpositioned vein grafted shunts. In all patients, lymphatic and lymph nodal tissues were sent for histological assessment, together with specimen of the interstitial matrix. Diagnostic investigations consisted in venous duplex scan and lymphoscintigraphy. Results were assessed clinically by volumetry performed preoperatively and postoperatively at 3 to 6 months and at 1, 3, and 5 years. The outcome obtained in treating lymphedemas at different stages was analyzed for volume reduction, stability of results with time, reduction of dermatolymphangioadenitis attacks, necessity of wearing elastic supports, and use of conservative measures postoperatively. Microsurgical lymphatic derivative and reconstructive techniques allow bringing about positive results in the treatment of peripheral lymphedema, above all in early stages when tissular changes are slight and allow almost a complete restore of lymphatic drainage.
authors.affiliation: Unit of Lymphatic Surgery, Department of Surgery, IRCCS S. Martino University Hospital-IST, Genoa, Italy. Francesco.boccardo@unige.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Boccardo
authors.forename: Ezio
authors.initials: E
authors.lastname: Fulcheri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Villa
authors.forename: Lidia
authors.initials: L
authors.lastname: Molinari
authors.forename: Corrado
authors.initials: C
authors.lastname: Campisi
authors.forename: Sara
authors.initials: S
authors.lastname: Dessalvi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Murdaca
authors.forename: Caterina
authors.initials: C
authors.lastname: Campisi
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Santi
authors.forename: Aurora
authors.initials: A
authors.lastname: Parodi
authors.forename: Francesco
authors.initials: F
authors.lastname: Puppo
authors.forename: Corradino
authors.initials: C
authors.lastname: Campisi
mesh_terms: D000714:Anastomosis, Surgical; D005500:Follow-Up Studies; D006801:Humans; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008209:Lymphedema / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery / Q000379:methods*; D011877:Radionuclide Imaging; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods*; D014680:Veins / Q000601:surgery*