Numbers on the rise. A problem that complicates with hot days. But it is possible to reduce the risks. 

When the temperature rises, the circumference of the legs and ankles increases. Swelling, heaviness, and in some cases, even an annoying tingling sensation that affects 1 in 2 women in summer, three times more than in winter. Men are not immune either, although they tend to ignore and underestimate the problem more than women. 

SWOLLEN LEGS:

To warn against the risk of lymphedema, especially in the face of what could be the hottest summer ever, is Corrado Campisi, president of the World Lymphology Congress to be held in Genoa from September 11 to 15, and professor of Plastic Surgery at the University of Catania. The event, which will bring together doctors, surgeons, nurses, physiotherapists, podiatrists, and many other specialists from around the world, represents an opportunity for updates on the treatment of lymphatic disorders and a platform for discussing the latest technological advancements. 

“When we talk about swollen legs and circulation, the first thing that comes to mind is blood, which flows through our arteries and veins thanks to the push of the heart,” explains Campisi, considered one of the leading specialists in Surgery and Microsurgery of the Lymphatic System and co-founder of the Campisi Clinic. 

The lymphatic vessels “However, in addition to the major ‘highways’ of the blood circulatory system, made up of arteries, veins, and capillaries, there is also a complex network – he continues – represented by the lymphatic system, which transports proteins, liquids, and lipids. This system, composed of lymphatic vessels and lymph nodes, allows lymph to be drained into body tissues, all over our body, before flowing into the bloodstream. A malfunction of this network can lead to abnormal swelling of the hands, arms, or legs, sometimes so extensive that they can resemble ‘elephant limbs.'” 

The main forms of lymphedema There are two main forms of lymphedema: “primary” lymphedema, due to congenital malformations of the lymphatic system vessels, and “secondary” lymphedema, caused by external adverse events that disrupt the normal function of the lymphatic system, such as lymph node removal and radiation therapy, both of which are part of cancer treatments. It is estimated that there are 350 million people with lymphedema worldwide, with 2 million in Italy alone. The numbers are on the rise, with about 40,000 more cases in Italy each year. 

“When there are abnormalities in the lymphatic circulation of our legs, there is an accumulation of fluids in the tissues, and when this condition, as often happens, is associated with insufficiency of the venous circulation in the limbs, the situation becomes even more complicated,” Campisi emphasizes. “It is not just an aesthetic problem, although it is relevant considering that in the summer, it can be difficult to walk or even wear shoes. The fluids that cannot be drained can become so dense, due to their high protein content, that they can compromise the proper oxygenation of the tissues, predisposing them to redness, eczema, dermatitis, ulcers, and infections.” 

How to reduce the risks The good news is that it is possible to reduce the risks and prevent complications. There are various levels of treatment depending on the severity of lymphedema, ranging from simple lifestyle changes to medications, physiotherapy, or even minimally invasive surgery. 

Symptoms “What makes a difference is the early diagnosis of the problem, which can only be achieved by identifying the first warning signs,” suggests the specialist. Initially, the symptoms can be subtle and difficult to detect in summer. The most common ones are heaviness in the legs and swollen ankles, which are often considered ‘normal’ and therefore neglectable. What cannot be ignored, however, is the difficulty in reducing the swelling in the legs: if you cannot achieve relief by elevating them or refreshing them with cold water, it is advisable to consult a specialist.” 

Diagnosis Initially, all the doctor needs is a single finger to check for a problem. “By pressing a finger on the ankle or leg, you can observe that, for a few seconds, a sort of dimple forms, which is a clear sign of lymphatic dysfunction,” says Campisi. “Clinical observation should also be supplemented with an EcoColorDoppler study of the venous circulation and a lymphoscintigraphy to check for lymphatic blockages,” he adds. 

At that point, there are various levels of treatment, ranging from simple lifestyle changes, such as avoiding smoking or prolonged standing, to the use of elastic stockings, which exert graduated compressive pressure, draining fluids from the ankle upward. Then there is pharmacological therapy with drugs like benzopyrones, antibiotics, antifungals, diethylcarbamazine, diuretics, up to manual lymphatic drainage with a specialized physiotherapist, mechanical drainage with methods like pressotherapy, or the use of multilayer bandages and exercise routines. More recently, there is the option of microsurgery, which can resolve lymphatic blockages directly at their source, thereby preventing recurrences. 

Surgery “The surgical procedures currently available for the treatment of lymphedema are diverse,” explains Campisi. “These range from lymphaticovenous bypasses that aim to create a peripheral physiological drainage to resolve the obstruction, to autologous tissue or lymph node transplants with the goal of creating a new lymphatic drainage system in the affected limb, to true lymphatic navigation-guided liposuction.” Campisi is also the creator of a new “ultrasound-assisted liposuction” technique that uses sound waves to “melt” lymphatic blockages and facilitate the surgical procedure. During the ISL congress, specialists will have the opportunity to exchange ideas on the latest microsurgical techniques for the lymphatic system. 

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IL MESSAGGERO VENETO 

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SALUTE 

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