Swelling, heaviness, tingling: warning signs of lymphedema. When to consult a specialist 

When the temperature rises, the circumference of the legs and ankles increases. Swelling, heaviness, and, in some cases, even an annoying tingling sensation, affect one in two women in the summer, three times more than in winter. Even men are not immune, although they tend to ignore and underestimate the problem more than women. Corrado Campisi, President of the World Lymphology Congress to be held in Genoa in September and Professor of Plastic Surgery at the University of Catania, is warning about the risk of lymphedema precisely during this hot season. During the congress, doctors, surgeons, nurses, physiotherapists, podiatrists, and other specialists from around the world will discuss updates in the treatment of lymphatic diseases. 


Professor Campisi, why do the legs swell? 

“When we talk about swollen legs and circulation, we immediately think of blood, which flows through arteries and veins thanks to the push of the heart. However, in addition to the major ‘highways’ of the blood circulatory system, made up of arteries, veins, and capillaries, there is also the intricate network of the lymphatic system that transports proteins, fluids, and lipids. This system consists of lymphatic vessels and lymph nodes, allowing lymph to be drained into the tissues throughout our body before flowing back into the bloodstream. Malfunctioning of this network can lead to abnormal swelling of the hands, arms, or legs. Sometimes, it can be so extensive that it makes the limbs look ‘elephantine.'” 

How widespread is the problem? 

“It is estimated that there are 350 million people with lymphedema worldwide, with 2 million in Italy. These numbers are steadily increasing, with about 40,000 more cases in Italy each year.” 

Let’s remember, it’s not just an aesthetic issue. 

“No, even though in the summer, it can be difficult to walk or even wear shoes. Fluids that cannot be drained can become so dense due to their high protein content that they can compromise proper tissue oxygenation, making them prone to redness, eczema, dermatitis, ulcers, and infections.” 

How can the risks be reduced? 

“There are various levels of treatment depending on the severity of lymphedema, from simple lifestyle changes such as avoiding smoking or standing for long periods to the use of elastic stockings. There are also medications, physiotherapy, and even minimally invasive surgery. The key is early diagnosis, by recognizing the initial warning signs.” 

What are those warning signs? 

“Initially, the symptoms can be difficult to understand, especially during the summer. The most common ones are heavy legs and swollen ankles, often considered ‘normal’ and therefore neglected. What cannot be ignored is the difficulty in reducing the swelling in the legs. If they don’t improve by elevating them and cooling them with cold water jets, it’s advisable to consult a specialist. Initially, a single finger from the doctor can verify that there is a problem.” 

How so? 

“By applying pressure with a finger to the ankle or leg, you can observe that, for a few seconds, a sort of dimple or pit forms, a clear sign of lymphatic dysfunction. Then, an EcoColorDoppler is necessary for studying venous circulation and a lymphoscintigraphy to check for lymphatic blockages.” 

New technique: sound waves that dissolve lymphatic blockages 

Fluids that cannot be drained can become so dense that they compromise proper tissue oxygenation, making them prone to redness, eczema, dermatitis, ulcers, and infections. Professor Corrado Campisi (in the photo) is also the inventor of a new technique called “ultrasound-assisted liposuction,” which uses sound waves to “dissolve” lymphatic blockages and facilitate surgical procedures. 

In the city, at the beach, traveling, or in the office: ten steps to follow Given the intense heat, here is a list of expert-recommended steps to “relieve” swollen legs in the summer. 

When all else fails, pharmacological therapy may be needed, including drugs such as benzopyrones, antibiotics, antifungals, diethylcarbamazine, diuretics, and manual lymphatic drainage by a specialized physiotherapist. Mechanical drainage using techniques like pressotherapy or the use of multilayer bandages and gymnastic exercises may also be recommended. More recently, microsurgery has been used to resolve lymphatic blockages, directly addressing the root cause and preventing recurrences. 

Several surgical procedures are available, including lymphaticovenous bypasses that aim to create a peripheral physiological drainage system to resolve obstructions, autologous transplantation of lymphatic tissue and/or lymph nodes to create a new lymphatic drainage system in the affected limb, and even true liposuctions guided by lymphatic navigation. 


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