Lymphatic Surgery for Lymphedema Treatment - The Genoa-Italy Protocol

Dr. Corrado Cesara Campisi, a lymphatic surgeon from Italy, talks about his protocol for lymphedema treatment. The idea is that this will help improve lymph flow, reduce swelling, and improve mobility. There is much confusion regarding the indication for surgery, and there are many options, such as ICG green lymphography and lymphangial magnetic resonance.

Corrado Cesare Campisi

The confusion in the indication of surgery, especially regarding reconstructive procedures ICG supports as many designs lymphedema patients as possible the depth of the tissue can minimize the resolution of the procedure, so it is also dangerous to perform choices and indications for surgery according only to ICG technique.  

The reconstructed methods are based on the lymphatic venous shunts, and the surgery performed for the lower limb is focused on the groin. The upper limb is concentrated in the upper bracket region, and a one-time single incision is used, and it can repair both the superficial and deep lymphatic system.  

Dr. Corrado shared a video showing the deep lymphatic pathways; lymphatics and this stage are highly delayed, so this is the best condition for lymphatic insurance because there is a strong flow in the lymphatic vessels, and the substitution does not damage the lymphatic vessel on of fibrotic tissue they can occlude the lumen of the lymphatic channel the deep lymphatic pathways can be effectively repaired. Hence, it is essential not to focus only on superficial lymphatics.  

Sharing images of profound lymphatic network impairment, in many cases, there is damage to both the superficial and deep lymphatic systems; there is a shunt between the superficial and deep lymphatic systems. There is an impairment of the deep system in both lower limbs, as you can see in this image, or there are more complex cases in which you have an impairment above the superficial and the system of both lower limbs like in this case. There is an image that can also help to study all the lymphatic pathways, so a total body lymphocytic can be helpful in primary cases, which could also be an impairment on the upper limbs, the abdomen, and the tract.  

In Another study, nearly 250 lymphoscintigraphy of primary and secondary lymphedemas unilateral arm leg or bilateral of the legs using the transport index, and we have seen that in most cases, there was an impairment of both the deep, superficial system up to 97.4% of cases on the other hand only superficial vessels were impaired singularly only up to 12.8 % of cases.

It is imperative to choose a suitable method because surgery can benefit the patient and his portfolio and quality of life. Of course, the earlier treatment is the best because there is a fibrotic adipose substitution in later stages, which makes the disease possibly also irreversible.  

Our protocol is based on phase one, where we perform many physical treatments during surgery. Then constructive surgery has its role, and then phase three, in which we follow up the patient with post-op care and eventually, if necessary, where we suggest liposuction and investigative liposuction remove the fibrotic issue in advanced cases.  

Physical exercise is essential for the patient to prepare for surgery or after surgery as a lifestyle and get patients back home with physical or home treatments that they can perform.  

Freestyle single-site MLVA:

There is an example of a lymphatic dissection; the vessels are in excellent condition for the anastomosis, and then we perform this anastomosis on one side of the groin or blackhead region, an optimal flow because the vein has no reflux.  

MLVA for lower limb lymphedema:

We can also, in some cases, repair the veining incompetence with external carboplatin; finally, the anastomosis is immensely powerful.  

MLVA for upper limb lymphedema:

The same for the upper limb, the same concept in the brachial region, and we perform a critical and incredibly significant study for the surgical planning also from the venous point of view and in this case, for example, in the video shared the median nerve the brachial artery was intense in the upper limb and the lymphatic channels.  

MLVA is much more potent than distal LVA:

The power of anastomosis depends on lymphatic function and vein competence. These are two main factors for the success of this surgery.  

MLVA pearls of wisdom: 

it is a single-side surgery; we have a meager infection rate, and on average, we use 15 vessels; there is no complaint for compression stockings if they are needed after surgery, and we have more than 35000 patients with at least 5 to 20 years of follow-up.  

When we should apply liposuction  

The liposuction that we use is preventive, and the liposuction is a lean passage below liposuction; we map the lymphatic system map the venous system, and we perform a liposuction after microsurgery, avoiding damage to the lymphatic collectors  

Dr. Corrado also shared pictures of the patient before and after surgery with outstanding results after physical treatment and microsurgery.  

At last, He also mentioned: It is not a standard no-look liposuction; we map the lymphatic system; we perform tiny incisions according to the lymphatic mapping that we perform pre-operatively together with the venous and superficial venous mapping. We perform safe liposuction in the dye; we can achieve the same in the lower part of the leg, at the ankle, and the foot as well, and we check the lymphatics before and after to see if there are any leakage from the fluorescent dye and to check possible damage to the lymphatic system. Hence, the main goal is to avoid lymphatic destruction.  

Dr. Corrado shared images of a patient with effective, long-lasting results saying that the results that can be achieved are highly significant, especially in terms of long-term because the main goal is to give the patient a better and consistent quality of life. 



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