Heat, the enemy of leg well-being. Just when we start to expose them, they suffer the consequences of high temperatures impacting circulation. The result? Swelling, heaviness, and pain that, in summer, affect one in two women according to estimates. And unfortunately, it’s not just a cosmetic problem: fluid accumulation can compromise proper tissue oxygenation, leading to redness, eczema, dermatitis, ulcers, and infections. 

SWOLLEN AND PAINFUL LEGS:

Corrado Campisi, president of the World Congress on Lymphology, which will be held in Genoa from September 11 to 15, outlines the problem, suggesting strategies for care and prevention. 

A Women’s Issue Men are not immune either, even if they tend to ignore and underestimate the problem. But women are decidedly more vulnerable. “When discussing swollen legs and circulation, thoughts immediately turn to blood, which flows through our body’s arteries and veins propelled by the heart,” explains Campisi, a professor of Plastic Surgery at the University of Catania and co-founder of the Campisi Clinic.

“However, beyond the main ‘highways’ of the blood circulatory system, there is also a complex network represented by the lymphatic system that transports proteins, fluids, and lipids. This system, consisting of lymphatic vessels and nodes, allows lymph to be drained in bodily tissues throughout our body before flowing back into the blood circulation. Dysfunction in this network can lead to abnormal swelling of the hands, arms, or legs, sometimes so extensive that they appear ‘elephant-like’.” 

Discovering Lymphedema There are two main forms of lymphedema: “primary,” due to congenital malformations of the vessels of the lymphatic system, and “secondary,” due to external adverse events that alter the normal function of the lymphatic system, such as lymph node removal and radiotherapy, both involved in oncological treatments. It is estimated that there are 350 million people with lymphedema worldwide, 2 million only in Italy, with about 40,000 more cases per year. 

“When the lymphatic circulation of our legs has anomalies, a buildup of fluids occurs in the tissues, and when this state is associated with venous insufficiency of the limbs, the situation complicates,” Campisi explains. In summer, it can be difficult to walk or even wear shoes. “The fluids that cannot be drained can become so dense, due to the high protein content, that they can compromise the proper oxygenation of the tissues, predisposing them to redness, eczema, dermatitis, ulcers, and infections,” the specialist adds. 

Recognizing the Problem Initially, a doctor needs only one finger to identify the problem. “The depression formed by the finger’s pressure on an ankle or leg for a few seconds is a clear sign of lymphatic dysfunction,” Campisi recounts. To clinical observation, an EcoColorDoppler for the study of the venous circulation and a lymphoscintigraphy to check for lymphatic congestion should also be associated. 

As for symptoms, at the beginning, they can be subtle and hard to detect in summer: the most common are heaviness in the legs and swollen ankles, often considered ‘normal’ and therefore negligible. “What should not be ignored, however, is the difficulty with which the legs deflate: if benefits are not achieved by lifting them and refreshing them with jets of cold water, it is wise to consult a specialist,” he recommends. 

Leg-Saving Interventions As for remedies, they range from lifestyle changes, like avoiding smoking or standing still for long periods, to the use of elastic stockings that exert gradual compressive pressure draining fluids from the ankle upwards. Then there is pharmacological therapy with benzopyrones, antibiotics, antifungals, diethylcarbamazine, diuretics, manual lymphatic drainage with a specialized physiotherapist, mechanical drainage such as pressotherapy, or the use of multilayer bandages and gymnastic exercises. 

More recently, microsurgery, which acts directly on the cause to prevent recurrence, has been used. “The surgical procedures are multiple: from lymphaticovenous bypasses, which aim to create a peripheral physiological discharge to resolve the obstruction, to autologous transplantation of lymphatic tissue or lymph nodes with the purpose of creating a new lymphatic drainage system in the affected limb, up to actual liposuctions guided by lymphatic navigation,” Campisi explains. 

Campisi has devised a new technique of “ultrasound liposuction,” which uses sound waves to “dissolve” lymphatic congestions and facilitate the surgical procedure. However, the ‘dark period’ for the legs has just begun. That’s why experts have developed a targeted ten-point plan: 

SOURCE: IL FOGLIO 

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