In the complex therapy for lymphedemas, the role to be played by surgery versus medical-physical conservative treatment can be easily defined.10 Combined physiotherapy is the treatment of choice for most lymphedemas. In nonresponsive cases
(up to 30-40%), the drainage function of the lymphatic circulation can, at least partially, can be recovered by lymphatic microsurgery performed as early as possible. The rather constant outcome can further be improved with subsequent conservative treatment. Major resective surgery is no longer justified. Only in rare cases, as soon as the results of microsurgical and medical conservative treatment have become stable, does minor resective surgery still find some indications for aesthetic-reductive purposes.
With regard to prevention of secondary lymphedemas, finally, early diagnosis plays an important role as well as the selection of high-risk patients for the onset of lymphostatic disease after oncological lymphadenectomies, especially if associated with radiotherapy. In these cases, early microsurgery is a valid suggestion in order to treat, from their very onset, lymphedemas which, based on a reasonable statistical probability, are expected to show unrelenting progression.
Based upon over 25 years clinical experience, we can conclude by emphasizing the efficacy of microsurgery for the treatment not only of patients with acquired lymphedema, but also with primary lymphostatic pathology, even in pediatrics, and moreover for the prevention of secondary lymphedema.
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