As temperatures rise, so does the circumference of legs and ankles. Swelling, heaviness, and sometimes annoying tingling, affect one in two women in the summer, three times more than in winter. Men are not immune to this condition, though they often ignore and underestimate the problem more than women. 


Corrado Campisi, president of the World Congress of Lymphology (scheduled for September 11-15 in Genoa) and professor of Plastic Surgery at the University of Catania, warns of the risk of lymphedema during what might be the hottest summer ever. 

This event, bringing together doctors, surgeons, nurses, physiotherapists, podiatrists, and other specialists from around the world, is an opportunity to update on lymphatic pathologies treatment and discuss new technological advancements. Campisi, a leading expert in Surgery and Microsurgery of the Lymphatic System and co-founder of Campisi Clinic, explains, “When we talk about swollen legs and circulation, we think of blood, flowing through the arteries and veins driven by the heart. But beyond the blood circulatory system’s main ‘highways,’ there is an intricate network represented by the lymphatic system, transporting proteins, liquids, and lipids.

This system, comprising lymphatic vessels and nodes, allows lymph to be drained in bodily tissues, before merging into the blood circulation. A malfunction in this network can lead to abnormal swelling of hands, arms, or legs, sometimes so extensive they resemble ‘elephant’ limbs.” There are two main forms of lymphedema: “primary,” due to congenital malformations of the lymphatic system, and “secondary,” due to external adverse events altering the lymphatic system’s normal function, like lymph node removal and radiotherapy in oncological treatments. Around 350 million people worldwide have lymphedema, with 2 million in Italy alone, increasing by approximately 40,000 each year in Italy. 

“When our legs’ lymphatic circulation is abnormal, fluid accumulates in the tissues, and when this state is associated with venous circulation insufficiency in the limbs, the situation complicates,” stresses Campisi. “It’s not just an aesthetic issue, as in summer, it can be hard to walk or even wear shoes. The undrained fluids can become so dense, due to high protein content, that they compromise proper tissue oxygenation, predisposing to redness, eczema, dermatitis, ulcers, and infections.” 

The good news is that risks can be reduced, preventing complications. Treatment levels vary from simple lifestyle changes to medications, physiotherapy, or even minimally invasive surgery. “What makes a difference is the timely diagnosis, which can only happen by identifying the first warning signs,” advises the specialist. “Initially, symptoms can be subtle and hard to detect in summer: the most common are heavy legs and swollen ankles, often considered ‘normal’ and therefore negligible.

However, what should not be ignored is the difficulty with which the legs deflate: if benefits cannot be obtained by lifting and cooling them with jets of cold water, it’s advisable to consult a specialist.” Initially, a doctor can verify there’s a problem with just one finger. 

“When pressure is applied by the finger on the ankle or leg, a dimple may form for a few seconds, a clear sign of lymphatic dysfunction,” says Campisi. “Clinical observation should therefore be combined with an EcoColorDoppler for studying the venous circle and lymphoscintigraphy to check for lymphatic congestion.” Various treatment levels range from simple lifestyle changes, like avoiding smoking or standing still for long periods, to wearing elastic stockings exerting graduated compressive thrust, draining fluids upwards.

Then there’s pharmacological therapy with, for example, benzopyrones, antibiotics, antifungals, diethylcarbamazine, diuretics, manual lymphatic drainage by a specialized physiotherapist, mechanical drainage with pressotherapy, or using multilayer bandages and gymnastic exercises. More recently, microsurgery can resolve lymphatic “congestion” by acting directly on the cause, thus preventing recurrences. 

“The surgical procedures currently available for lymphedema treatment are varied,” explains Campisi: “from lymphaticovenous bypasses, creating a peripheral physiological discharge to resolve obstruction, to autologous transplant of lymphatic tissue and/or lymph nodes to create a new lymphatic drainage system in the affected limb, up to real lymphatic navigation-guided liposuctions.” 

The expert also devised a new “ultrasound liposuction” technique, using sound waves to “dissolve” lymphatic congestion and facilitate surgery. At the ISL congress, specialists will discuss the latest microsurgical techniques on the lymphatic system. Meanwhile, experts have developed a decalogue to “lighten” swollen legs in the summer:

1) Regular moderate physical activity; 2) Exercise preferably in the morning; 3) Wear comfortable shoes with 2-2.5 cm heels; 4) Avoid walking barefoot; 5) Take walks in the sea up to the waist; 6) Avoid sun exposure during hot hours; 7) Frequently change position when sitting or standing for long periods; 8) Sleep with legs slightly raised; 9) Don’t cross legs when sitting; 10) On long trips, wear elastic sheath and move legs during short breaks. 


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