BOCCARDO FRANCESCO, CAMPISI CORRADO, BARBERIS ANDREA, CAMPISI CATERINA, ACCOGLI SUSANNA, CAMPISI CORRADINO
Department of Surgery Unit of Lymphatic Surgery and Microsurgery
San Levitra No Prescription Martino Hospital, University of Genoa, Italy
E-mail: francesco.boccardo@unige.it
BACKGROUND
Translation is related to the bi-directional process of applying
ideas, insights and discoveries generated through basic science
inquiry to the treatment and prevention of human diseases. The
challenge consists in integrating molecular insights in Clinical
Lymphology, taking to potential advancements from research to
clinic and to the community for the benefit of patients. In the same
way clinical problems that cannot find proper solutions can be
returned to laboratory for further researches.
The problem of prevention of lymphatic injuries in surgery is
extremely important if we think about the frequency of both early
complications such as lymphorrhea, lymphocele, wound
dehiscence and infections and late complications such as
lymphangites and lymphedema. Nowadays, it is possible to
identify risk patients and prevent these lesions or treat them at an
early stage.
Methods. Authors report their experiences in the application of
Translational Lymphology in Surgery, pointing out some
examples of prevention of lymphatic injuries. After an accurate
diagnostic approach prevention is based on different technical
procedures. It is very important to follow-up the patient not only
clinically but also by lymphoscintigraphy.
Results and Conclusions. It was identified a protocol of
prevention of secondary limb lymphedema that included , from the
diagnostic point of view, lymphoscintigraphy and, as concerns
therapy, it recognized also a role to early microsurgery. It is
necessary to accurately follow-up the patient who has undergone
an operation at risk for the appearance of lymphatic complications
and, even better, to assess clinically and by lymphoscintigraphy
the patient before surgical operation.
KEY WORDS: Translational Lymphology, Surgery, Teaching
Models, Research, Clinical applications
INTRODUCTION
In the prevention of injuries to the lymphatic system we must
consider a primary and a secondary prevention.
Primary prevention includes anamnesis, which aims at pointing
out risk factors, such as biological factors (constitution, sex-
THE EUROPEAN JOURNAL
OF lymphology
and related problems
VOLUME 21 • No. 61 • 2010
INDEXED IN EXCERPTA MEDICA
SURGERY AND TRANSLATIONAL LYMPHOLOGY: CLINICAL
APPLICATIONS IN PREVENTING LYMPHATIC INJURIES
BOCCARDO FRANCESCO, CAMPISI CORRADO, BARBERIS ANDREA, CAMPISI CATERINA,
ACCOGLI SUSANNA, CAMPISI CORRADINO
Department of Surgery
Unit of Lymphatic Surgery and Microsurgery
San Martino Hospital, University of Genoa, Italy
E-mail: francesco.boccardo@unige.it
hormonal status, familiarity, etc.), hygienic, environmental and
climatic factors, working activity and the most significant events
in remote pathological anamnesis, and protective factors, such as
style and habits of life (diet, sanitary measures, sports activity,
etc.), social-sanitary culture of Preventive Medicine and
epidemiological studies. However, for most of risk and protective
factors, mechanism of action are not known yet (1-4).
The rate of occurrence of post-operative complications after
inguinal lymphadenectomy reported in Literature is of 6-40% for
seromas or lymphocele, 2-4% for haematomas, 17-65% for wound
dehiscence, 6-20% for wound infection and 22-80% for
lymphoedema (5-7).
The problem of prevention of lymphatic injuries in surgery is
extremely important if we think about the frequency of both early
complications such as lymphorrhea, lymphocele, wound
dehiscence and infections and late complications such as
lymphangites and lymphedema. Nowadays, it is possible to
identify risk patients and prevent these lesions or treat them at an
early stage (8-11).
We tried to perform a protocol of prevention which includes
diagnostic investigations such as lymphoscintigraphy and early
therapeutic strategies which involve both physical and surgical
procedures.
MATERIALS AND METHODS
The main causes of secondary lymphatic injuries are represented
by surgical operations, irradiations, infections, infestations
(filariasis), traumas, metastatic lymphnodal involvement, etc.
The high risk surgical operations include: radical mastectomy,
Wertheim-Meigs operation, oncologic operation in urology,
abdominal surgery, lymphadenectomies in “critical sites” (groin
and axilla). Other operations are represented by exeresis of
lipomas in critical 4seohunt.com/www/www.eurolymphology.org. sites, saphenectomy, inguino-crural
hernioplasty, etc.
Our experience includes the treatment of a patient with left
supraclavicular chylocele due to thoracic trauma, in which we
could repair the thoracic duct fistula by microsurgical technique
avoiding its surgical closure. In a similar case of thoracic duct
fistula, but due to bioptic excision of a supraclavicular lymphnode,
we could reconstruct the thoracic duct preventing its ligation. In