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Volume 10 Supplement 1

de Senectute: Age and Health Forum

  • Meeting abstract
  • Open Access

Obesity and lymphedema in geriatrics: combined therapeutical approaches

  • 1,
  • 1,
  • 1,
  • 1 and
  • 1
BMC Geriatrics201010 (Suppl 1) :A49

https://doi.org/10.1186/1471-2318-10-S1-A49

  • Published:

Keywords

  • Obesity
  • Lymphedema
  • Geriatric Patient
  • Lymph Transport
  • Capacity Index

Background

Obesity combined with lymphedema, especially in geriatrics, is more than the sum of the two diseases [1] because it causes the diaphragm to be above its normal position, impairing its movement. As a consequence, a fundamental mechanism that supports lymph flow is significantly decreased. Obesity associated with lymphedema represents a cause of a highly invalidating condition. The purpose of this preliminary report is to propose a system of treatment, assessing the efficacy of a combined approach of lymphostatic disease in obese geriatric patients.

Materials and methods

A group of 6 geriatric patients affected by obesity (BMI>35) and lower limb lymphedema (II to III stage) had been enrolled in this preliminary study. Patients underwent a protocol of treatment of lymphedema by Complete Decongestive Therapy (CDT) according to Földi’s method. Patients had been under observation for six-twelve months. They were evaluated during this period of follow-up at 1-3-6 and 12 months. After 12 months those patients who were not significantly responsive to non-operative methods, without any important regression of previous lymphedema staging, had a lymphangioscintigraphy performed in order to evaluate a right indication to lymphatic-venous microsurgical anastomoses [2].

Results

Two patients showed a significant reduction (>50% in comparison to previous volumetry) of lower limbs affected by lymphstasis after CDT procedures, with a high level of patient satisfaction. Four patients, on the guide of lymphangioscintigraphy showing a relevant impairment of lymph transport capacity index of lower limbs, underwent Derivative Lymphatic-Venous Bypass microsurgical procedure (LVA), performing a simultaneous operation at both groin sites (Figure1 and 2). Clinical and lymphoscintigraphic post-operative follow-up (evaluated at 3-5 years after surgery) showed a long-lasting improvement, with a marked edema and volumetric reduction maintained by a proper lifestyle, remedial exercise, elastic stockings and periodical CDT procedures.
Figure 1
Figure 1

Obesity and lymphedema: an example of successful outcome of the combined therapeutical non-operative and microsurgical approaches.

Figure 2
Figure 2

Obesity and lymphedema: an example of successful outcome of the combined therapeutical non-operative and microsurgical approaches, after.

Conclusions

Considering the high incidence of obesity and the not-unfrequent association with lower limb lymphedema, the method proposed of a combined approach in geriatric patients can represent an effective and long-lasting therapeutic solution.

Authors’ Affiliations

(1)
Department of Surgery, Unit of Lymphatic Surgery and Microsurgery, San Martino Hospital, University of Genoa, Italy

References

  1. Földi M, Földi E: Földi’s Textbook of Lymphology. 2006, Mosby-Elsevier, 2ndGoogle Scholar
  2. Campisi C, Davini D, Bellini C, Taddei G, Villa G, Fulcheri E, et al: Lymphatic microsurgery for the treatment of lymphedema. Microsurgery. 2006, 26 (1): 65-9. 10.1002/micr.20214.PubMedView ArticleGoogle Scholar

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