Between 1990 and 1992, 39 patients affected with arm edema following either radical mastectomy or modified radical mastectomy or segmental mastectomy plus axillary dissection, have been treated with resectional (lymphangectomy) or microsurgical (LVA) therapy. The series is composed of cases with lymphedema not responsive to medical and physical therapy. In the preoperative period the affected limbs have been investigated with the following clinical and instrumental exams: volume increasing evaluation, dynamic lymphoscintigraphy, Doppler venous fluximetry, US scan, and MR: the latter has been carried out only in the most severe cases of lymphedema. Some exams have been repeated during the follow-up period to obtain a better evaluation of the results. Twenty-seven patients with a grade 2 lymphedema (absent or minimal fibredema) underwent a microsurgical indirect lymphovenous shunt LVA) operation, according to Degni-Cordeiro. Small fasciotomies (between 1 and 4) along limbs have been always combined with LVA, with the aim to aid lymphatic drainage through muscles and deep circle. Three patients with a grade 2 lymphedema and venous limb hypertension underwent multiple fasciotomies alone. Nine patients with a severe grade 3 lymphedema (limb elephantiasis and diffuse fibredema) underwent resectional operations; in 8 cases a partial superficial lymphangectomy (Kondoleon's operation), and in 1 case a total superficial lymphangectomy (Servelle's operation) were performed. Totally, patients of the three groups of operations showing positive responses (classes II-III), were: 85% 3 months later (33/39), 75% 6 months later (27/36), and 59% 12 months later (17/29). Considering each group of operations, the results are the following. Patients that underwent microsurgical therapy (LVA + fasciotomies) showed positive responses in 85% 3 months later (23/27), in 81% 6 months later (21/26), and in 59% 12 months later (13/22). Patients that underwent resectional macrosurgery (Kondoleon, Servelle) showed positive responses in 78% (7/9)3 months later, and in 50% (4/8) 6 months later; this data were unmodified 12 months later (3/6).
|Number of pages||9|
|Publication status||Published - 1995|
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