Long‐term results after lymphatic‐venous anastomoses for the treatment of obstructive lymphedema
Identifieur interne : 005241 ( Istex/Corpus ); précédent : 005240; suivant : 005242Long‐term results after lymphatic‐venous anastomoses for the treatment of obstructive lymphedema
Auteurs : Corradino Campisi ; Francesco Boccardo ; Angelo Zilli ; Alberto Macci ; Francesco NapoliSource :
- Microsurgery [ 0738-1085 ] ; 2001.
Abstract
Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic‐venous anastomoses; of these, 446 patients were available for long‐term follow‐up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo‐Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow‐up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long‐term results indicate that lymphatic‐venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with earlier operations because patients referred earlier usually have fewer lymphatic alterations.
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DOI: 10.1002/micr.1025
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Long‐term results after lymphatic‐venous anastomoses for the treatment of obstructive lymphedema</title><author><name sortKey="Campisi, Corradino" sort="Campisi, Corradino" uniqKey="Campisi C" first="Corradino" last="Campisi">Corradino Campisi</name><affiliation><mods:affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>Via Assarotti 46/1, 16122 Genova, Italy</mods:affiliation></affiliation></author><author><name sortKey="Boccardo, Francesco" sort="Boccardo, Francesco" uniqKey="Boccardo F" first="Francesco" last="Boccardo">Francesco Boccardo</name><affiliation><mods:affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Zilli, Angelo" sort="Zilli, Angelo" uniqKey="Zilli A" first="Angelo" last="Zilli">Angelo Zilli</name><affiliation><mods:affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Macci, Alberto" sort="Macci, Alberto" uniqKey="Macci A" first="Alberto" last="Macci">Alberto Macci</name><affiliation><mods:affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Napoli, Francesco" sort="Napoli, Francesco" uniqKey="Napoli F" first="Francesco" last="Napoli">Francesco Napoli</name><affiliation><mods:affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:AF871BB340749F200E85DFF7331A451B42190E23</idno><date when="2001" year="2001">2001</date><idno type="doi">10.1002/micr.1025</idno><idno type="url">https://api.istex.fr/document/AF871BB340749F200E85DFF7331A451B42190E23/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">005241</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">005241</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Long‐term results after lymphatic‐venous anastomoses for the treatment of obstructive lymphedema</title><author><name sortKey="Campisi, Corradino" sort="Campisi, Corradino" uniqKey="Campisi C" first="Corradino" last="Campisi">Corradino Campisi</name><affiliation><mods:affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>Via Assarotti 46/1, 16122 Genova, Italy</mods:affiliation></affiliation></author><author><name sortKey="Boccardo, Francesco" sort="Boccardo, Francesco" uniqKey="Boccardo F" first="Francesco" last="Boccardo">Francesco Boccardo</name><affiliation><mods:affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Zilli, Angelo" sort="Zilli, Angelo" uniqKey="Zilli A" first="Angelo" last="Zilli">Angelo Zilli</name><affiliation><mods:affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Macci, Alberto" sort="Macci, Alberto" uniqKey="Macci A" first="Alberto" last="Macci">Alberto Macci</name><affiliation><mods:affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</mods:affiliation></affiliation></author><author><name sortKey="Napoli, Francesco" sort="Napoli, Francesco" uniqKey="Napoli F" first="Francesco" last="Napoli">Francesco Napoli</name><affiliation><mods:affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Microsurgery</title><title level="j" type="sub">Frontiers in Microsurgery: Recent Advances in Experimental Microsurgery</title><title level="j" type="alt">MICROSURGERY</title><idno type="ISSN">0738-1085</idno><idno type="eISSN">1098-2752</idno><imprint><biblScope unit="vol">21</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="135">135</biblScope><biblScope unit="page" to="139">139</biblScope><biblScope unit="page-count">5</biblScope><publisher>John Wiley & Sons, Inc.</publisher><pubPlace>New York</pubPlace><date type="published" when="2001">2001</date></imprint><idno type="ISSN">0738-1085</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0738-1085</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic‐venous anastomoses; of these, 446 patients were available for long‐term follow‐up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo‐Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow‐up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long‐term results indicate that lymphatic‐venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with earlier operations because patients referred earlier usually have fewer lymphatic alterations.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>lymphedema</json:string><json:string>lymphatic</json:string><json:string>anastomosis</json:string><json:string>microsurgery</json:string><json:string>microsurgical</json:string><json:string>campisi</json:string><json:string>pazienti</json:string><json:string>venous</json:string><json:string>boccardo</json:string><json:string>lymphology</json:string><json:string>microanastomoses</json:string><json:string>lymphoscintigraphy</json:string><json:string>sono</json:string><json:string>obstructive</json:string><json:string>average reduction</json:string><json:string>surg</json:string><json:string>lymphangioscintigraphy</json:string><json:string>excess volume</json:string><json:string>lymphatics</json:string><json:string>stati</json:string><json:string>angiol</json:string><json:string>riduzione</json:string><json:string>lymphovenous</json:string><json:string>lymphoscintigraphic</json:string><json:string>lymphatic vessels</json:string><json:string>clinical experience</json:string><json:string>volume changes</json:string><json:string>obstructive lymphedema</json:string><json:string>dermal backflow</json:string><json:string>primary lymphedemas</json:string><json:string>shunt</json:string><json:string>lymph</json:string><json:string>derivative</json:string><json:string>edema</json:string><json:string>night rest stage</json:string><json:string>secondary lymphedemas</json:string><json:string>notevole distanza</json:string><json:string>lymphedema patients</json:string><json:string>peripheral edema</json:string><json:string>single stitch</json:string><json:string>entry hole</json:string><json:string>lymphovenous shunts</json:string><json:string>declivous position</json:string><json:string>peripheral lymphedema</json:string><json:string>conservative measures</json:string><json:string>significant improvement</json:string><json:string>secondary lymphedema</json:string><json:string>microlymphatic venous anastomoses</json:string><json:string>volar surface</json:string><json:string>microsurgical anastomoses</json:string><json:string>subjective improvement</json:string><json:string>water volumetry</json:string><json:string>lymphatic microsurgery</json:string><json:string>experimental study</json:string><json:string>plast reconstr surg</json:string><json:string>reconstructive microsurgery</json:string></teeft></keywords><author><json:item><name>Corradino Campisi M.D.</name><affiliations><json:string>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</json:string><json:string>Via Assarotti 46/1, 16122 Genova, Italy</json:string></affiliations></json:item><json:item><name>Francesco Boccardo M.D.</name><affiliations><json:string>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</json:string></affiliations></json:item><json:item><name>Angelo Zilli M.D.</name><affiliations><json:string>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</json:string></affiliations></json:item><json:item><name>Alberto Macciò M.D.</name><affiliations><json:string>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</json:string></affiliations></json:item><json:item><name>Francesco Napoli M.D.</name><affiliations><json:string>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</json:string></affiliations></json:item></author><articleId><json:string>MICR1025</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic‐venous anastomoses; of these, 446 patients were available for long‐term follow‐up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo‐Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow‐up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long‐term results indicate that lymphatic‐venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. 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Martino Hospital, University of Genoa, Italy<address><country key="IT"></country></address></affiliation><affiliation>Via Assarotti 46/1, 16122 Genova, Italy</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Francesco</forename><surname>Boccardo</surname><roleName type="degree">M.D.</roleName></persName><affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0002"><persName><forename type="first">Angelo</forename><surname>Zilli</surname><roleName type="degree">M.D.</roleName></persName><affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0003"><persName><forename type="first">Alberto</forename><surname>Macciò</surname><roleName type="degree">M.D.</roleName></persName><affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy<address><country key="IT"></country></address></affiliation></author><author xml:id="author-0004"><persName><forename type="first">Francesco</forename><surname>Napoli</surname><roleName type="degree">M.D.</roleName></persName><affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy<address><country key="IT"></country></address></affiliation></author><idno type="istex">AF871BB340749F200E85DFF7331A451B42190E23</idno><idno type="DOI">10.1002/micr.1025</idno><idno type="unit">MICR1025</idno><idno type="toTypesetVersion">file:MICR.MICR1025.pdf</idno></analytic><monogr><title level="j" type="main">Microsurgery</title><title level="j" type="sub">Frontiers in Microsurgery: Recent Advances in Experimental Microsurgery</title><title level="j" type="alt">MICROSURGERY</title><idno type="pISSN">0738-1085</idno><idno type="eISSN">1098-2752</idno><idno type="book-DOI">10.1002/(ISSN)1098-2752</idno><idno type="book-part-DOI">10.1002/micr.v21:4</idno><idno type="product">MICR</idno><imprint><biblScope unit="vol">21</biblScope><biblScope unit="issue">4</biblScope><biblScope unit="page" from="135">135</biblScope><biblScope unit="page" to="139">139</biblScope><biblScope unit="page-count">5</biblScope><publisher>John Wiley & Sons, Inc.</publisher><pubPlace>New York</pubPlace><date type="published" when="2001"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><abstract xml:lang="en" style="main"><head>Abstract</head><p>Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic‐venous anastomoses; of these, 446 patients were available for long‐term follow‐up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo‐Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow‐up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long‐term results indicate that lymphatic‐venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with earlier operations because patients referred earlier usually have fewer lymphatic alterations.</p></abstract><abstract xml:lang="it" style="main"><p>Nel corso degli ultimi 25 anni, 665 pazienti affetti da linfedema ostruttivo sono stati sottoposti ad intervento di anastomosi microchirurgiche linfatico‐venose. Quattrocentoquarantasei pazienti sono stati seguiti anche a notevole distanza di tempo dall'operazione. I risultati sono stati valutati obiettivamente mediante volumetria ad acqua e linfoscintigrafia. Preoperatoriamente sono state utilizzate la linfoscintigrafia, linfografia (in pazienti con patologia da reflusso gravitazionale) e l'Eco‐Doppler. Abbiamo potuto registrare un miglioramento soggettivo in 578 pazienti (87%). Obiettivamente, le valutazioni volumetriche hanno dimostrato un miglioramento significativo in 552 pazienti (83%), con una riduzione media del volume in eccesso pari al 67%. Dei 446 pazienti seguiti anche a notevole distanza di tempo dall'intervento, 379 (85%) sono stati in grado di utilizzare la guaina elastica in modo discontinuo, con un follow‐up medio di oltre 7 anni ed una riduzione volumetrica media del 69%. Si è, altresì, verificata una riduzione dell'incidenza delle linfangiti dell'87% dopo microchirurgia. Nei pazienti con miglioramento del quadro clinico, il drenaggio ha permesso di riscontrare anche una marcata riduzione di consistenza del linfedema. L'edema periferico alla mano o al piede si è ridotto significativamente nella maggior parte dei pazienti. Questi risultati a lungo termine indicano come le anastomosi linfatico‐venose giochino un ruolo importante nel trattamento del linfedema ostrutivo e come siano da considerare il trattamento di scelta nei pazienti non adeguatamente responsivi alla terapia conservativa medico‐fisica‐riabilitativa. © 2001 Wiley‐Liss, Inc. 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date="2001-03-15"></event><event type="firstOnline" date="2001-06-27"></event><event type="publishedOnlineFinalForm" date="2001-06-27"></event><event type="xmlConverted" agent="Converter:JWSART34_TO_WML3G version:2.3.2 mode:FullText source:HeaderRef result:HeaderRef" date="2010-03-09"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-02-02"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-11-01"></event></eventGroup><numberingGroup><numbering type="pageFirst">135</numbering><numbering type="pageLast">139</numbering></numberingGroup><correspondenceTo>Via Assarotti 46/1, 16122 Genova, Italy</correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:MICR.MICR1025.pdf"></link></linkGroup></publicationMeta><contentMeta><countGroup><count type="figureTotal" number="4"></count><count type="tableTotal" number="1"></count><count type="referenceTotal" number="18"></count><count type="wordTotal" number="2106"></count></countGroup><titleGroup><title type="main" xml:lang="en">Long‐term results after lymphatic‐venous anastomoses for the treatment of obstructive lymphedema</title><title type="short" xml:lang="en">Lymphatic‐Venous Anastomoses for Lymphedemas</title></titleGroup><creators><creator xml:id="au1" creatorRole="author" affiliationRef="#af1" corresponding="yes"><personName><givenNames>Corradino</givenNames><familyName>Campisi</familyName><degrees>M.D.</degrees></personName><contactDetails><email>campisi@unige.it</email></contactDetails></creator><creator xml:id="au2" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Francesco</givenNames><familyName>Boccardo</familyName><degrees>M.D.</degrees></personName></creator><creator xml:id="au3" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Angelo</givenNames><familyName>Zilli</familyName><degrees>M.D.</degrees></personName></creator><creator xml:id="au4" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Alberto</givenNames><familyName>Macciò</familyName><degrees>M.D.</degrees></personName></creator><creator xml:id="au5" creatorRole="author" affiliationRef="#af1"><personName><givenNames>Francesco</givenNames><familyName>Napoli</familyName><degrees>M.D.</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="af1" countryCode="IT" type="organization"><unparsedAffiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</unparsedAffiliation></affiliation></affiliationGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Abstract</title><p>Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic‐venous anastomoses; of these, 446 patients were available for long‐term follow‐up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo‐Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow‐up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long‐term results indicate that lymphatic‐venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with earlier operations because patients referred earlier usually have fewer lymphatic alterations.</p></abstract><abstract type="main" xml:lang="it"><p>Nel corso degli ultimi 25 anni, 665 pazienti affetti da linfedema ostruttivo sono stati sottoposti ad intervento di anastomosi microchirurgiche linfatico‐venose. Quattrocentoquarantasei pazienti sono stati seguiti anche a notevole distanza di tempo dall'operazione. I risultati sono stati valutati obiettivamente mediante volumetria ad acqua e linfoscintigrafia. Preoperatoriamente sono state utilizzate la linfoscintigrafia, linfografia (in pazienti con patologia da reflusso gravitazionale) e l'Eco‐Doppler. Abbiamo potuto registrare un miglioramento soggettivo in 578 pazienti (87%). Obiettivamente, le valutazioni volumetriche hanno dimostrato un miglioramento significativo in 552 pazienti (83%), con una riduzione media del volume in eccesso pari al 67%. Dei 446 pazienti seguiti anche a notevole distanza di tempo dall'intervento, 379 (85%) sono stati in grado di utilizzare la guaina elastica in modo discontinuo, con un follow‐up medio di oltre 7 anni ed una riduzione volumetrica media del 69%. Si è, altresì, verificata una riduzione dell'incidenza delle linfangiti dell'87% dopo microchirurgia. Nei pazienti con miglioramento del quadro clinico, il drenaggio ha permesso di riscontrare anche una marcata riduzione di consistenza del linfedema. L'edema periferico alla mano o al piede si è ridotto significativamente nella maggior parte dei pazienti. Questi risultati a lungo termine indicano come le anastomosi linfatico‐venose giochino un ruolo importante nel trattamento del linfedema ostrutivo e come siano da considerare il trattamento di scelta nei pazienti non adeguatamente responsivi alla terapia conservativa medico‐fisica‐riabilitativa. © 2001 Wiley‐Liss, Inc. MICROSURGERY 21:135–139 2001</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Long‐term results after lymphatic‐venous anastomoses for the treatment of obstructive lymphedema</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>Lymphatic‐Venous Anastomoses for Lymphedemas</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Long‐term results after lymphatic‐venous anastomoses for the treatment of obstructive lymphedema</title></titleInfo><name type="personal"><namePart type="given">Corradino</namePart><namePart type="family">Campisi</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</affiliation><affiliation>Via Assarotti 46/1, 16122 Genova, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Francesco</namePart><namePart type="family">Boccardo</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Angelo</namePart><namePart type="family">Zilli</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Alberto</namePart><namePart type="family">Macciò</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Francesco</namePart><namePart type="family">Napoli</namePart><namePart type="termsOfAddress">M.D.</namePart><affiliation>Department of Specialistic Surgical Sciences, Anaesthesiology and Organ Transplants (DISCAT), Emergency Surgical Clinic Section, Lymphology and Microsurgery Center, S. Martino Hospital, University of Genoa, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article"></genre><originInfo><publisher>John Wiley & Sons, Inc.</publisher><place><placeTerm type="text">New York</placeTerm></place><dateIssued encoding="w3cdtf">2001</dateIssued><dateCaptured encoding="w3cdtf">2001-03-10</dateCaptured><dateValid encoding="w3cdtf">2001-03-15</dateValid><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType><extent unit="figures">4</extent><extent unit="tables">1</extent><extent unit="references">18</extent><extent unit="words">2106</extent></physicalDescription><abstract lang="en">Over the past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical lymphatic‐venous anastomoses; of these, 446 patients were available for long‐term follow‐up study. Objective assessment was undertaken by water volumetry and lymphoscintigraphy. Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo‐Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%). Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been able to discontinue the use of conservative measures, with an average follow‐up of more than 7 years and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis after microsurgery. In those patients who improved, drainage resulted in increased softness of the limbs. Peripheral edema (hand and foot) diminished considerably in most patients. These long‐term results indicate that lymphatic‐venous anastomoses have a place in the treatment of obstructive lymphedema and should be the therapy of choice in patients who are not sufficiently responsive to nonsurgical treatment. Improved results can be expected with earlier operations because patients referred earlier usually have fewer lymphatic alterations.</abstract><abstract lang="it">Nel corso degli ultimi 25 anni, 665 pazienti affetti da linfedema ostruttivo sono stati sottoposti ad intervento di anastomosi microchirurgiche linfatico‐venose. Quattrocentoquarantasei pazienti sono stati seguiti anche a notevole distanza di tempo dall'operazione. I risultati sono stati valutati obiettivamente mediante volumetria ad acqua e linfoscintigrafia. Preoperatoriamente sono state utilizzate la linfoscintigrafia, linfografia (in pazienti con patologia da reflusso gravitazionale) e l'Eco‐Doppler. Abbiamo potuto registrare un miglioramento soggettivo in 578 pazienti (87%). Obiettivamente, le valutazioni volumetriche hanno dimostrato un miglioramento significativo in 552 pazienti (83%), con una riduzione media del volume in eccesso pari al 67%. Dei 446 pazienti seguiti anche a notevole distanza di tempo dall'intervento, 379 (85%) sono stati in grado di utilizzare la guaina elastica in modo discontinuo, con un follow‐up medio di oltre 7 anni ed una riduzione volumetrica media del 69%. Si è, altresì, verificata una riduzione dell'incidenza delle linfangiti dell'87% dopo microchirurgia. Nei pazienti con miglioramento del quadro clinico, il drenaggio ha permesso di riscontrare anche una marcata riduzione di consistenza del linfedema. L'edema periferico alla mano o al piede si è ridotto significativamente nella maggior parte dei pazienti. Questi risultati a lungo termine indicano come le anastomosi linfatico‐venose giochino un ruolo importante nel trattamento del linfedema ostrutivo e come siano da considerare il trattamento di scelta nei pazienti non adeguatamente responsivi alla terapia conservativa medico‐fisica‐riabilitativa. © 2001 Wiley‐Liss, Inc. MICROSURGERY 21:135–139 2001</abstract><relatedItem type="host"><titleInfo><title>Microsurgery</title><subTitle>Official Journal of the International Microsurgical Society and the European Federation of Societies for Microsurgery</subTitle></titleInfo><titleInfo type="abbreviated"><title>Microsurgery</title></titleInfo><name type="personal"><namePart type="given">Antonio</namePart><namePart type="family">Di Cataldo</namePart><namePart type="termsOfAddress">M.D.</namePart></name><name type="personal"><namePart type="given">Stefano</namePart><namePart type="family">Puleo</namePart><namePart type="termsOfAddress">M.D.</namePart></name><name type="personal"><namePart type="given">Robert</namePart><namePart type="family">Zhong</namePart><namePart type="termsOfAddress">M.D.</namePart></name><genre type="journal">journal</genre><subject><genre>article-category</genre><topic>Original Article</topic></subject><identifier type="ISSN">0738-1085</identifier><identifier type="eISSN">1098-2752</identifier><identifier type="DOI">10.1002/(ISSN)1098-2752</identifier><identifier type="PublisherID">MICR</identifier><part><date>2001</date><detail type="title"><title>Frontiers in Microsurgery: Recent Advances in Experimental Microsurgery</title></detail><detail type="volume"><caption>vol.</caption><number>21</number></detail><detail type="issue"><caption>no.</caption><number>4</number></detail><extent unit="pages"><start>135</start><end>139</end><total>5</total></extent></part></relatedItem><identifier type="istex">AF871BB340749F200E85DFF7331A451B42190E23</identifier><identifier type="DOI">10.1002/micr.1025</identifier><identifier type="ArticleID">MICR1025</identifier><accessCondition type="use and reproduction" contentType="copyright">Copyright © 2001 Wiley‐Liss, Inc.</accessCondition><recordInfo><recordContentSource>WILEY</recordContentSource><recordOrigin>John Wiley & Sons, Inc.</recordOrigin></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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