LYMPHEDEMA SURGERY
Surgical techniques are intended for cases that do not respond to medical treatment and include two types of procedures: ABLATIVE or PHYSIOLOGICAL
Which type of technique to choose or how to combine the different techniques will be determined based on the examination, the interview with the patient, and the results of lymphatic resonance, an essential preoperative test that allows us to have a direct view of the type and degree of lymphedema being addressed.
For each case, a personalized therapeutic plan will be established according to the needs of the individual patient, in order to achieve the highest possible level of care.
The goal always remains to help the patient regain as much autonomy as possible; each specialist studies the most suitable compromise, combining what theoretical rules dictate and what the person experiences.
ABLATIVE SURGICAL PROCEDURES
They are based on the removal of pathological tissue using different techniques, all aimed at reducing the weight and size of the affected areas.
-MODIFIED LIPOSUCTION
Generally reserved for cases in which the affected areas are largely composed of fibrotic tissues (the so-called lipoedema); this type of procedure allows for selective remodeling of the affected areas while preserving the competent lymphatic pathways, thus allowing intervention where physiological techniques are not ideally indicated.
This technique too, in cases where different degrees of lymphedema coexist, can be used in combination with ablative and physiological procedures to achieve results aimed at a better and more complete level of care.
-REDUCTION PROCEDURES
Generally reserved for the most severe cases of lymphedema, where the affected areas are largely composed of fibrotic tissues, ablative surgery aims to remove more or less extensive amounts of pathological tissue, thus primarily alleviating problems related to the size and weight of the affected limbs, significantly improving the patient's quality of life. Secondly, this type of procedure allows for selective remodeling of the affected areas, allowing intervention on areas that are little or not at all responsive to other treatments.
Last and perhaps most important is the possibility of facilitating the activity of the remaining competent lymphatic vessels, thus helping to break the vicious cycle that often leads to irreversible and unresponsive worsening of the disease. All this proves extremely useful in cases where these procedures are combined with physiological procedures (autologous lymph node transplant and lympho-venous bypass) or with liposuction; in fact, the different techniques often combine synergistically, allowing for even more sophisticated levels of care.
PHYSIOLOGICAL SURGICAL PROCEDURES
These types of procedures aim to reconstruct competent lymphatic pathways, allowing drainage of excess lymph from diseased areas. These are sophisticated procedures performed using super-specialized techniques, with the aid of an operating microscope.
-LYMPH NODE TRANSPLANT (ALNT - VLNT)
Reserved for cases in which the lymph node system is hypoplastic or absent or where there is an interruption in lymphatic drainage flow, whether of iatrogenic, traumatic, or post-infectious origin.
The procedure consists of the autologous transplant of a tissue unit, called a flap, containing lymph nodes. This flap is transferred to the site where lymph nodes are absent or non-competent. The most commonly used donor sites are the lateral cervical, dorsal, and inguinal regions. About three to four lymph nodes are harvested to avoid complications in the donor area.
The transplanted tissue not only promotes the reabsorption of excess lymph present in the recipient area, but also allows the establishment of a new balance that will be long-lasting through the formation of new lymphatic vessels.
Lymph node autotransplantation is also indicated for preventive purposes. The approach to oncological patients is seeing an essential combination between oncological demolitive surgery and conservative/reconstructive plastic surgery.
Consider cases where a mastectomy is necessary for carcinoma. In the same surgical session, after oncological removal, breast reconstruction is performed with an abdominal fat flap, rich in adipose tissue to restore the volume and shape of the breast and lymph nodes to prevent the onset of upper limb lymphedema.
-LYMPHO-VENOUS ANASTOMOSIS or LYMPHATIC VENOUS BYPASS
In its various forms, according to our philosophy, this type of technique is best indicated in cases of hyperplastic or hypertrophic lymphedema, where lymphatic vessels are present, sometimes even more than normal in terms of length and/or number, but are not competent, thus unable to perform their transport function. The purpose of these procedures is to create several bypasses under the microscope between small lymphatic vessels and subcutaneous venules, thus allowing a diversion of the flow from the blocked lymphatic system to the venous system.
For more information, please refer to the website http://www.centrolinfedema.it, the website of the team of experts I am part of.
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