Treatment and prevention of lymphatic Injuries in surgery and trauma

Authors describe their clinical experience in the treatment of patients referred to the Unit of Lymphatic Surgery and affected from injuries to the lymphatic system due to surgery or trauma. Epidemiological data point out the significant prevalence of lymphatic injuries correlated mainly to oncological operations in the ambit of general, gynaecological and urological surgery. Moreover, also venous and arterial surgery may be responsible of the appearance of early and late lymphatic complications. Diagnosis includes ultrasonography, CT, MRI, lymphoscintigraphy and oil contrast lymphography. Prevention is based on different technical details, for example a proper skin incision, lymphnodal dissection, adeguate use of drain tubes, right compressive medications on wounds, etc.. It is very important to follow-up the patient not only clinically but also by lymphoscintigraphy. For the treatment, different procedures are used including microsurgical methods, CO2 LASER, laparoscopic approach, etc. It was identified a protocol of prevention of secondary limb lymphedema that included above all, from the diagnostic point of view, lymphoscintigraphy and, as concerns therapy, it recognized also a role to early microsurgery. Authors conclude that 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 the surgical operation.