“ULCERS AND INFECTIONS ARE RISKS”. HERE’S THE EXPERTS’ TEN-POINT PLAN Swelling, heaviness, and in some cases, even an annoying tingling that can hinder walking or simply standing. Swollen legs can become a nightmare in summer. In this hot season, one in two women suffers from it, three times more than in winter. Men are not immune either, though they often tend to ignore and underestimate the problem more than women do.

Corrado Campisi, president of the World Congress of Lymphology to be held in Genoa from September 11 to 15 and a professor of Plastic Surgery at the University of Catania, warns of the risk of lymphedema, ahead of what might be the hottest summer ever. The event, which will bring together doctors, surgeons, nurses, physiotherapists, podiatrists, and many other specialists from around the world, is an opportunity for updating in the treatment of lymphatic pathologies and discussing the latest technological innovations. 

SWOLLEN LEGS IN SUMMER:

“When we talk about swollen legs and circulation, our thoughts immediately go to the blood, which flows through our body’s arteries and veins propelled by 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.

“However, beyond the major ‘highways’ of the blood circulatory system, there is also a complex network – he continues – represented by the lymphatic system that transports proteins, liquids, and lipids. This system, made up 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 hands, arms, or legs, sometimes so extensive that they resemble ‘elephant’ limbs.” 

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. Numbers are growing, with about 40,000 more each year in Italy. 

“When the lymphatic circulation of our legs presents anomalies, a buildup of fluids occurs in the tissues and when this state, as often happens, is associated with a venous insufficiency of the limbs, the situation complicates,” emphasizes Campisi.

“It’s not just an aesthetic problem, although relevant considering that in summer it can be difficult to walk or even wear shoes. The fluids – he continues – 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 good news is that risks can be reduced by preventing complications. There are various levels of treatment depending on the severity of lymphedema: from simple lifestyle changes to medications, physiotherapy, or even minimally invasive surgery.

“Making a difference is the timely diagnosis of the problem, which can only occur by identifying the first warning signs – the specialist suggests -. Initially, the symptoms can be subtle and hard to detect in summer: the most common are heaviness in the legs and swollen ankles, which are often considered ‘normal’ and therefore negligible. What instead cannot be ignored is the difficulty with which the legs deflate: if no benefit is obtained by lifting them and refreshing them with jets of cold water, it is good to consult a specialist.” 

Initially, a doctor needs only one finger to verify that there is a 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,” says Campisi. “To clinical observation, an EcoColorDoppler for the study of the venous circulation and a lymphoscintigraphy to check for lymphatic congestion should also be associated,” he adds.

At that point, there are various levels of treatment: from simple lifestyle changes, like avoiding smoking or standing still for long periods, to the use of compression stockings, which exert a gradual compressive force draining fluids from the ankle upwards. And then there’s pharmacological therapy with, for example, benzopyrones, antibiotics, antifungals, diethylcarbamazine, diuretics up to manual lymphatic drainage with a specialized physiotherapist, mechanical drainage with, for example, pressotherapy or the use of multilayer bandages and gymnastic exercises. 

Much more recent is the recourse to microsurgery, which is capable of resolving the “congestion” of the lymphatic system, acting directly on the cause, thus preventing recurrences. “The surgical procedures currently available for the treatment of lymphedema – explains Campisi – are multiple: from lymphaticovenous bypasses, which aim to create a peripheral physiological discharge to resolve the obstruction, to autologous transplantation of lymphatic tissue and/or lymph nodes with the aim of creating a new lymphatic drainage system in the affected limb, up to actual liposuctions guided by lymphatic navigation.

” The expert is also the creator of a new technique of “ultrasound liposuction”, which uses sound waves to “dissolve” lymphatic congestion and facilitate the surgical procedure. At the ISL congress, specialists will have the opportunity to discuss the latest microsurgical techniques on the lymphatic system. 

Meanwhile, as temperatures rise, experts have developed a ten-point plan to “lighten” swollen legs in summer: 

SOURCE: IL FATTO QUOTIDIANO 

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