One in 2 women suffers from it. Campisi (ISL): “Blame it on ‘lymphatic congestion,’ now solvable even with minimally invasive procedures.” Experts provide a guide to improving circulation and achieving lighter legs. 

When the temperature rises, the circumference of the legs and ankles increases. Swelling, heaviness, and in some cases, even annoying tingling affect 1 in 2 women in summer, which is triple the rate compared to winter. Men are not immune to it either, although they tend to ignore and underestimate the problem more than women. Corrado Campisi, President of the World Congress of Lymphology to be held in Genoa from September 11 to 15, and Professor of Plastic Surgery at the University of Catania, warns of the risk of lymphedema, especially in what could be the hottest summer ever.

The event will bring together doctors, surgeons, nurses, physiotherapists, podiatrists, and many other specialists from around the world, providing an opportunity for updates on lymphatic disease treatment and discussions on the latest technological advancements. 

Causes of Swollen Legs “When it comes to swollen legs and circulation, we immediately think of blood, which flows through our arteries and veins, pushed by the heart,” explains Campisi, considered one of the leading experts in Surgery and Microsurgery of the Lymphatic System and co-founder of the Campisi Clinic. “However, in addition to the major ‘highways’ of the blood circulatory system, made up of arteries, veins, and capillaries, there is also an intricate network represented by the lymphatic system. It transports proteins, fluids, and lipids.

This system, consisting of lymphatic vessels and lymph nodes, allows lymph to be drained into the body’s tissues at any point before it returns to the bloodstream. Malfunction in this network can lead to an abnormal swelling of the hands, arms, or legs, sometimes so extensive that they appear as ‘elephant limbs.'” 

Primary Forms of Lymphedema There are two primary forms of lymphedema: “primary” forms, which result from congenital malformations of the lymphatic system vessels, and “secondary” forms, which result from adverse external events that disrupt the normal functioning of the lymphatic system, such as lymph node removal and radiotherapy, 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. These numbers are on the rise, with Italy seeing around 40,000 additional cases each year.

“When the lymphatic circulation in our legs has anomalies, there is an accumulation of fluids in the tissues. When this condition, as often happens, is also associated with venous insufficiency in the limbs, the situation becomes more complicated,” emphasizes Campisi. “It’s not just an aesthetic issue, although that’s relevant. In the summer, walking or even wearing shoes can be challenging. The fluids that cannot be drained can become so dense due to a high protein content that they can compromise the proper oxygenation of the tissues, making them prone to redness, eczema, dermatitis, ulcers, and infections.” 

The Importance of Timely Diagnosis The good news is that risks can be reduced by preventing complications. There are various levels of treatment depending on the severity of lymphedema, ranging from simple lifestyle changes to medication, physiotherapy, or even minimally invasive surgery. “Early diagnosis of the problem makes a difference, and it can only be achieved by identifying the first warning signs,” suggests the specialist. Initially, symptoms may be subtle and challenging to detect during the summer, with the most common being leg heaviness and swollen ankles, which are often considered ‘normal’ and therefore overlooked.

What cannot be ignored, however, is the difficulty in reducing leg swelling. If elevation and cold water jets do not provide relief, it is advisable to consult a specialist. Initially, a single finger is enough for the doctor to identify the problem. “When pressure is applied by the finger to the ankle or leg, a sort of dimple may form for a few seconds, a clear sign of lymphatic dysfunction,” says Campisi. Clinical observation should also be combined with an EcoColorDoppler study of the venous circulation and a lymphoscintigraphy to check for lymphatic congestion. 

Treatment Options At that point, there are various treatment options: from simple lifestyle changes like quitting smoking or avoiding prolonged standing, to the use of compression stockings that exert graduated pressure to drain fluids from the ankle upwards. Additionally, pharmacological therapy with benzopyrones, antibiotics, antifungals, diethylcarbamazine, and diuretics may be considered, as well as manual lymphatic drainage by a specialized physiotherapist, mechanical drainage using techniques like pneumatic compression, and the use of multilayer bandages and exercise programs. More recently, microsurgery has been used to address lymphatic congestion directly, preventing recurrences. 

Surgical Procedures Campisi explains, “Currently, there are multiple surgical procedures available for the treatment of lymphedema. These range from lymphaticovenous bypasses aimed at creating peripheral physiological drainage to resolve obstructions, to autologous tissue and/or lymph node transplantation with the goal of creating a new lymphatic drainage system in the affected limb, and even true liposuctions guided by lymphatic navigation.” Campisi is also the creator of a new “ultrasound-assisted liposuction” technique that uses sound waves to dissolve lymphatic obstructions and facilitate surgical procedures. At the ISL congress, specialists will have the opportunity to discuss the latest microsurgical techniques for the lymphatic system. 

Expert’s Decalogue for “Lightening” Swollen Legs Meanwhile, in anticipation of summer, experts have compiled a decalogue to help “lighten” swollen legs during the summer: 


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