Lymphoedema: modern diagnostic and therapeutic aspects.

The author reports his clinical experience regarding the diagnostic assessment of patients with lymphedema and the selection criteria for those assigned to microsurgery. Patients were classified according to aetiology and stages and sites of the lymphedema and underwent a diagnostic protocol consisting of lymphoscintigraphy, lymphography (in selected cases), Doppler venous flowmetry and manometry, lymphangio-RM and, in the case of angiodysplasias, phlebography and arteriography. This protocol is essential in deciding the appropriate microsurgical technique in those selected for surgery, whether derivative lympho-venous anastomosis or reconstructive lymphatic-venous-lymphatic plasty. The results of surgery were assessed both clinically (with the aid of photographs, water volumetry and measurements of limb circumference) and by lymphangioscintigraphy, and were classified as marked, moderate or mild regression of oedema. The overall results were very encouraging, particularly those of patients in the earlier stages of the condition. With regard to secondary prevention, early diagnosis plays an important role as does the identification of patients at high risk for the onset of lymphostatic disease after oncological lymphadenectomies, especially when associated with radiotherapy. In such cases, in order to combat right from the outset those lymphedemas which, based on statistical probability, are expected to show unrelenting progression if untreated, early microsurgery is a reasonable option.