Lymphedema staging and surgical indications in geriatric age
© Campisi et al; licensee BioMed Central Ltd. 2010
Published: 19 May 2010
Lymphedema, refractory to non-operative methods , may be managed by surgical treatment. Indications include insufficient lymphedema reduction by well performed medical and physical therapy (less than 50%), recurrent episodes of lymphangitis, intractable pain, worsening limb function, patient unsatisfied of the results obtained by non-operative methods and willing to proceed with surgical options. In this study Authors report a new lymphedema staging and their wide clinical experience in the microsurgical treatment of peripheral lymphedema [2, 3] in geriatric age.
Materials and methods
A."Latent" lymphedema, without clinical evidence of edema, but with impaired lymph transport capacity ( provable by lymphoscintigraphy) and with initial immuno-histochemical alterations of lymph nodes, lymph vessels and extracellular matrix.
B.“Initial” lymphedema, totally or partially decreasing by rest and draining position, with worsening impairment of lymph transport capacity and of immuno-histochemical alterations of lymph collectors, nodes and extracellular matrix.
A. “Increasing” lymphedema, with vanishing lymph transport capacity, relapsing lymphangitic attacks, fibroindurative skin changes, and developing disability.
B. "Column shaped" limb fibrolymphedema, with lymphostatic skin changes, suppressed lymph transport capacity and worsening disability.
A. Properly called “elephantiasis”, with scleroindurative pachydermitis, papillomatous lymphostatic verrucosis, no lymph transport capacity and life-threatening disability.
B. “Extreme elephantiasis” with total disability.
Microsurgical lymphatic-venous anastomoses have a place in the treatment of peripheral lymphedema in geriatrics especially in early stages, and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment.
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