Swollen legs, a problem for one in two women
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As the temperature rises, the circumference of the legs and ankles increases. Swelling, heaviness and, in some cases, even an annoying tingling which, in summer, affects 1 in 2 women, three times as much as in winter. Not even men are immune to it, even if they tend to ignore and underestimate the problem much more than women do.
To warn of the risk of lymphedema, in view of what could be the hottest summer season ever, is Corrado Campisi, president of the World Congress of Lymphology to be held in Genoa from 11 to 15 September, and professor of Plastic Surgery at the University of Catania. The event, which will bring together doctors, surgeons, nurses, physiotherapists, podiatrists and many other specialists from all over the world, represents an opportunity for updating in the treatment of lymphatic pathologies and for discussion on the main technological innovations.
“When we talk about swollen legs and circulation, our thoughts go directly to the blood, which flows through the arteries and veins of our body through the push of the heart”, explains Campisi, considered one of the leading specialists in Surgery and Microsurgery of the Lymphatic System and co -founder of the Campisi Clinic.
The lymph vessels
“However, in addition to the great ‘highways’ of the blood circulatory system, made up of arteries, veins and capillaries, there is also an intricate network – he continues – represented by the lymphatic system which transports proteins, liquids and lipids. This system, made up of lymphatic vessels and lymph nodes, allows the lymph to be drained into the body tissues, in every point of our body, before pouring into the bloodstream.A malfunction of this network can lead to an abnormal swelling of the hands, arms or legs.Sometimes like this ‘ extended to look like ‘elephant’ limbs.”
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The main forms of lymphedema
There are two main forms of lymphedema. The “primary” ones, due to congenital malformations of the vessels of the lymphatic system, and the “secondary” ones, due to external adverse events that alter the normal function of the lymphatic system, such as the removal of lymph nodes and radiotherapy, both foreseen in oncological treatments . It is estimated that there are 350 million people with lifedema in the world, 2 million in Italy alone. Strongly growing numbers, in our country about 40 thousand more a year.
“When the lymphatic circulation of our legs presents anomalies, there is an accumulation of liquids in the tissues and when this state, as often happens, is associated with an insufficiency of the venous circulation of the limbs, the picture becomes more complicated – underlines Campisi -. Not it is only an aesthetic problem, although relevant in consideration of the fact that in summer it can be difficult to walk or even wear shoes.Liquids that cannot be drained can become so thick, due to the high content of proteins, which can compromise the correct oxygenation of the tissues, predisposing them to redness, eczema, dermatitis, ulcers and infections”.
How to reduce the risks
The good news is that it is possible to reduce the risks by preventing complications. There are various levels of treatment depending on the severity of lymphedema: from simple lifestyle changes to medications, physiotherapy or even minimally invasive surgery.
Symptoms
“The timely diagnosis of the problem makes the difference, which can only happen by identifying the first alarm bells – suggests the specialist -. Initially the symptoms can be subtle and difficult to intercept in the summer: the most common are heaviness in the legs and swollen ankles, which very often are considered ‘normal’ and therefore negligible.What however cannot be ignored is the possible difficulty with which the legs deflate: if you are unable to obtain benefits by lifting them and refreshing them with jets of cold water, it is best to consult a specialist”.
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The diagnosis
Initially, a single finger is enough for the doctor to verify that there is a problem. “The pressure exerted by the finger on the ankle or leg can cause a sort of dimple to form for a few seconds, an evident sign of a lymphatic dysfunction”, says Campisi. “Clinical observation should therefore also be associated with an EcoColorDoppler for the study of the venous circulation and a lymphoscintigraphy to check for the presence of lymphatic blockages”, she adds.
At that point there are various levels of treatment: ranging from simple lifestyle changes, such as avoiding smoking or standing still for a long time, to the use of elastic stockings, which exert a graduated compressive thrust by draining liquids from the ankle upwards. And then pharmacological therapy with for example benzopyrones, antibiotics, antifungals, diethylcarbamazine, diuretics up to manual lymphatic drainage with a specialized physiotherapist, mechanical drainage with for example pressotherapy or the use of multilayer bandages and gymnastic exercises. Much more recent is the use of microsurgery which is able to resolve the lymphatic “traffic jam”, acting directly on the cause, thus preventing recurrences.
Surgery
“There are many surgical procedures currently available for the treatment of lymphedema – explains Campisi -: they range from lymphatic-venous bypasses which aim to create a peripheral physiological discharge with which to resolve the obstruction to autologous transplantation of lymphatic tissue and/or lymph nodes with the aim of creating a new lymphatic drainage system in the affected limb, up to real liposuction guided by lymphatic navigation”. The expert is also the creator of a new “ultrasonic liposuction” technique, which uses sound waves to “dissolve” lymphatic blockages and facilitate the surgical procedure. On the occasion of the ISL congress, specialists will have the opportunity to discuss the latest microsurgical techniques on the lymphatic system.
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