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 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