CLyFT PROTOCOL: COMPLETE LYMPHEDEMA FUNCTIONAL THERAPY

CLyFT PROTOCOL: COMPLETE LYMPHEDEMA FUNCTIONAL THERAPY

Appropriate treatment of lymphedema cannot ignore the combination of physical therapy and surgical therapy: the first and the third phases include specific rehabilitative treatments customized according to each specific case; the second phase is the surgical one: microsurgical (MLVA) and, subsequently, if necessary, FLLA LVSP; an adequate “follow-up” is at least 3-5 years after a suitable treatment: the case database of our Center also presents long-term follow-up of to 20 years from the surgical operation, essential criterion to reach a stable and long-lasting condition.

ALGORITHM FOR TREATMENT OF THE PERIPHERAL LYMPHEDEMA OF LOWER / UPPER LIMBS

ALGORITHM FOR TREATMENT OF THE PERIPHERAL LYMPHEDEMA OF LOWER / UPPER LIMBS

  1. PRIMARY PREVENTION, with particular reference to patients receiving oncological treatment: at the same time as the removal of lymph nodes for tumor staging/treatment (eg axillary, inguinal or pelvic), it is possible to perform Multiple Lymphatic-Venous Anastomoses (MLVA) avoiding, in this way, the onset of secondary lymphedema; microsurgical prevention is also applicable to all patients at risk of developing post-surgical lymphedema: typical examples are cardio-vascular surgery (peripheral venous insufficiency, femoral cannulation), cosmetic (liposuction), orthopedic (knee prosthesis) / hip), general (diagnostic lymph node biopsies, inguinal hernioplasty).
  2. SECONDARY PREVENTION, early treatment of peripheral lymphedema: thanks to a timely diagnosis, it is possible to intervene surgically (MLVA) in an initial stage of the disease; decongestant physical therapy has much better results if performed after reconstructive microsurgical surgery, this is enhanced by the fact that surgery removes the obstructive nature of lymphatic edema.
  3. TERTIARY PREVENTION, treatment of the complications of chronic lymph stasis: after the microsurgical intervention (MLVA) the degree of volumetric reduction of lymphedema is evaluated; in advanced stages there remains a portion of inflammatory fibrotic-adipose tissue that represents a further obstacle to the correct lymphatic circulation: thanks to the Fibro-Lipo-Lymph-Aspiration with Procedure “Lymph Vessel Sparing” (FLLA LVSP) surgery, this fibro-lipo-lymphedematous residue is removed without the risk of damaging the lymphatic structures previously reconstructed by microsurgery.

TREATMENT ALGORITHM ON THE BASIS OF THE LYMPHOSCINTIGRAPHY RESULT

TREATMENT ALGORITHM ON THE BASIS OF THE LYMPHOSCINTIGRAPHY RESULT

Once the clinical diagnosis of lymphedema has been performed, the specialist doctor should recommend specific imaging tests, including lymphoscintigraphy of the superficial and deep lymphatic circulation with the calculation of the lymphatic transport index; the surgical indication is thus based on the outcome of the lymphoscintigraphic examination: in up to 12.8% of cases a microsurgical correction of the superficial system can be sufficient to obtain a satisfactory result; however, in most cases (up to 97.4%) a contextual correction of the deep lymphatic system is necessary and only the Multiple Lymphatic-venous Anastomosis (MLVA) approach that uses both superficial and deep lymphatic vessels can achieve the best long-term results.