Microsurgery of lymphedema. Interview with Dr. Alessandro Piperno.

Swelling, heaviness, itching, tingling in the legs or arms. These are the main symptoms of lymphedema, a disease that can affect the upper and lower limbs, especially women. To illustrate a clear picture of its manifestations and, above all, of its treatment with surgical treatment, is Dr. Alessandro Piperno, specialist in Orthopedics and Traumatology and expert in Microsurgery and lymphedema surgery.

Dr. Piperno, first of all, what is, in short, lymphedema?

Lymphedema is a disorder of the lymphatic circulation, a pathological condition in which the lymph, transported in the lymphatic system, is no longer drained from the limbs but stagnates in the limbs themselves, mainly causing swelling, a sense of heaviness, itching and, in cases with greater complications, even recurrent infections.

What are the causes that determine it?

Lymphedema can be primary, therefore occur due to congenital problems, or, more often, secondary, or due to pathological states or as a result of oncological surgery. Removal of lymph nodes, for example, can cause lymphedema.

How is lymphedema diagnosed?

First of all, a visit to the specialist is necessary who, after an accurate medical history, advises the patient to carry out first-level diagnostic tests, to exclude, for example, that it is not vascular problems of veins and arteries. If lymphedema is already suspected, the examination to be carried out is lymphoscintigraphy.

Excessive heat, I imagine, worsens the symptoms. What can be done to alleviate them?

Socks and compression sheaths can help but do not completely solve the problem, they only serve to temporarily "buffer" the discomfort.

Dr. Piperno, what is, then, the solution to effectively treat lymphedema?

The answer is in microsurgery, in surgical treatment with minimally invasive technique for the restoration of a lymph drainage route, necessary to solve the problem upstream. The surgeon uses dedicated instruments to make small incisions, in the arm or leg, to redirect the lymphatic fluid through an alternative route that can bypass the "traffic jam" and make it drain through small veins.

Is venous lymphatic bypass the best and most effective solution for everyone?

This approach provides the best results in cases of mild or moderate lymphedema, so much so that in a few days it can significantly reduce the symptoms and the circumference of the limbs. In severe cases, however, it can still relieve symptoms.

The post-operative?

Recovery is rapid: within a few days of surgery you can resume normal walking. In the post-operative period, the use of compression stockings and sheaths is indicated.

For more information on the lymphedema treatment service at UPMC Salvator Mundi click here.