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.
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.
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