Surgical Research, Staging-Guided Technical Procedures and Long-Term Clinical Outcomes for the Treatment of Peripheral Lymphedema: the Genoa Protocol
<p>The Author 's vast surgical experience in the treatment of primary and secondary peripheral lymphedema is reported. The objective is to describe the techniques and the long-lasting clinical outcomes based on more than 45 years research and clinical applications, with particular referen...
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Journal of Surgery and Surgical Research - Peertechz Publications,
2020-05-28.
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LEADER | 00000 am a22000003u 4500 | ||
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001 | peertech__10_17352_2455-2968_000096 | ||
042 | |a dc | ||
100 | 1 | 0 | |a Corrado Cesare Campisi |e author |
700 | 1 | 0 | |a Lidia Molinari |e author |
700 | 1 | 0 | |a Caterina Sara Campisi |e author |
700 | 1 | 0 | |a Giuseppe Villa |e author |
700 | 1 | 0 | |a Ezio Fulcheri |e author |
700 | 1 | 0 | |a Corradino Campisi |e author |
245 | 0 | 0 | |a Surgical Research, Staging-Guided Technical Procedures and Long-Term Clinical Outcomes for the Treatment of Peripheral Lymphedema: the Genoa Protocol |
260 | |b Journal of Surgery and Surgical Research - Peertechz Publications, |c 2020-05-28. | ||
520 | |a <p>The Author 's vast surgical experience in the treatment of primary and secondary peripheral lymphedema is reported. The objective is to describe the techniques and the long-lasting clinical outcomes based on more than 45 years research and clinical applications, with particular reference to staging-guided derivative and reconstructive lymphatic microsurgery at a single site, and to complementary, sequential, minimally invasive procedures of selective liposuction.</p><p>5.046 cases of patients (demographic characteristics are at length described) affected by upper and/or lower limb lymphedema, between 1973 and 2020, underwent lymphatic microsurgery and, between 2012 and 2020, Fibro-Lipo-Lymph-Aspiration according to Lymph Vessel Sparing Procedure (FLLA-LVSP), for latest stages of Lymphedema previously treated by Lymphatic Microsurgery with partial improvement of the disease. Derivative Multiple Lymphatic-Venous Anastomoses (MLVA) or, in selected cases of Phlebolymphedema absolutely contraindicating derivative procedures, lymphatic pathway reconstruction, using interpositioned vein grafted shunts (Multiple-Lymphatic-Venous-Lymphatic Anastomose - MLVLA), above all at lower limbs, were performed at a single site, either the brachial-axillary or inguinal-crural region.</p><p>Adopted surgical techniques are described in detail. As far as exposition of results is concerned, patients were followed up for a minimum of 5 years to over 20 years. Clinical outcomes included excess limb volume (ELV), frequency of dermatolymphangioadenitis (DLA) attacks, lymphoscintigraphy, and use of conservative therapies.</p><p>Compared with preoperative conditions, patients obtained significant reduction in ELV of over 90%, with an average follow-up of 10 years or more. Over 96% of patients with earlier stages of disease (stage IB or IIA) progressively stopped using conservative therapies and over 80% of patients with later stages (stages IIB and III) significantly decreased the frequency of physical therapies and discontinued compressive garments or stockings. DLA attacks considerably reduced by over 95%.</p><p>MLVA or MLVLA techniques when performed at a single site produce excellent outcomes in the treatment of both primary and secondary lymphedemas, giving the possibility of a complete restoration of lymphatic flow in early stages of disease, when tissue changes are minimal. For late stages of lymphedema only partially responding to MLVA or MLVLA, FLLA-LVSP sequential procedures can significantly improve the long-term clinical outcomes. </p><p>Staging-guided treatment of peripheral lymphedema, according to Authors' Genoa Protocol, carries out contextual target of primary, secondary and tertiary prevention in the potential worsening of the disease.</p> | ||
540 | |a Copyright © Corrado Cesare Campisi et al. | ||
546 | |a en | ||
655 | 7 | |a Review Article |2 local | |
856 | 4 | 1 | |u https://doi.org/10.17352/2455-2968.000096 |z Connect to this object online. |