Lymphedema
Lymphedema: what is it and what are the treatments
Lymphedema is stagnation of lymph caused by an abnormality of the lymphatic system. It is a clinical picture characterized, therefore, by the blocking or slowing of the lymphatic circulation in the affected limbs. In this condition, the lymphatic transport does not allow the total management of a load of cells and plasma proteins.
Almost 50% of lymphedema has a primary origin and a congenital basis of l lymphangial-adeno-dysplasia. This means that the pathology is attributable to a malformation and a malfunction of the lymphatic vessels and/or lymph nodes.
The remaining half of the lymphedema is of parasitic origin, post-surgical, secondary to the treatment of breast cancer, other malignant tumours of the male and female genitourinary hope, malignant melanoma or caused by functional problems of overload of the lymphatic circulation.
Primary Lymphedema
Primary lymphedema can be congenital, early or late.
Primary congenital lymphedema
is already present at birth
Primary congenital lymphedema
appears before the age of 35
Late primary lymphedema occurs
after 35 years of age
At the base of the different types of congenital lymphedema, there are different forms of dysplasia, classified in LAD I (dysplasia of the lymphatic vessels), LAD II (dysplasia of the lymph nodes) and LAAD (dysplasia of the lymphatics and lymph nodes).
Secondary Lymphedema
Secondary lymphedema has a high incidence and mainly affects the female sex. In particular, secondary lymphedema of the upper limb occurs in women who have undergone mastectomy or quadrantectomy with axillary lymphadenectomy, registering an incidence equal to 20-25% (and the percentage rises to 35-40% when a radiotherapy treatment was performed).
The classification of secondary lymphedema includes:
Post-surgical secondary lymphedema
Post-actinic secondary lymphedema
Post-traumatic secondary lymphedema
Secondary post-lymphangitic lymphedema
Secondary post-thrombophlebitis lymphedema (or phlebolymphedema)
Parasitic secondary lymphedema
How to treat the lymphedema
The main exam with which to perform the diagnostic definition of oedema is Lymphoscintigraphy, which allows you to:
Confirm the lymphatic nature
Identify the cause, if possible
With the state the extension of the disease
Assess the degree of functional impairment of the lymphatic circulation.
There arecomplementary and/or supplementary investigations that can provide further information about the best surgical approach to lymphedema.
Lymphedema therapy can be physical, pharmacological and surgical. The first includes physiotherapy, lymphatic drainage (both manual and mechanical) and combined physical therapy treatments. On the other hand the secondincludes diet, benzopyrones, diuretics, antibiotics, diethylcarbamazine and antifungals. As for the surgical treatment, however, the specialist can proceed with microsurgery, derivative or reconstructive, or with liposuction (with FLLA-LVSP procedure, “Lymph Vessel Spacing”).
