Role of lymphoscintigraphy in the indications to microsurgical treatment of peripheral lymphedemas

The value of lymphoscintigraphy is very high in those cases of early stage peripheral lymphedemas, because it allows to study both superficial and deep lymphatic circulation in a very precise and not only functional but also morphological way, giving important data to the surgeon to establish the correct therapeutic strategy. Lymphoscintigraphy, in fact, represents the common diagnostic examination which is usually performed by lymphedema patients addressed to an operation of lymphatic microsurgery, together with the study of venous circulation by means of duplex scan. In the most advanced cases of lymphedema, lymphoscintigraphy proved not to be so reliable, as the tracer remains at the site of injection without any sign of progression. This outcome might lead to a misunderstanding of the etiology and physiopathological mechanism of the pathology, which can be wrongly interpreted as congenitally based on a condition of lymphatic and lymphnodal aplasia (so called Nonne-Milroy disease). Thus, it is useful to underline how there might exist some cases of "dumb lymphoscintigraphy" notwithstanding the presence of proper lymphatic-lymphnodal structures.