Primary LYmphedema Multidisciplinary Approach in Patients Affected by Primary Lower Extremity Lymphedema

Author:

Ciudad Pedro12,Bolletta Alberto3ORCID,Kaciulyte Juste4ORCID,Manrique Oscar J.15,Escandón Joseph M.6ORCID

Affiliation:

1. Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima 15082, Peru

2. Academic Department of Surgery, Faculty of Medicine, Federico Villarreal National University, Lima 15084, Peru

3. Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56125 Pisa, Italy

4. Unit of Plastic and Reconstructive Surgery, Department of Surgery “P.Valdoni”, Sapienza University of Rome, Policlinico Umberto I, 00185 Rome, Italy

5. Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY 14642, USA

6. Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA

Abstract

Background: Primary lymphedema is a chronic condition caused by a developmental abnormality of the lymphatic system, leading to its malfunction. Various surgical options, including physiologic and excisional procedures, have been proposed. The aim of this study was to present a comprehensive algorithm for the treatment of primary lower extremity lymphedema: the Primary LYmphedema Multidisciplinary Approach (P-LYMA). Methods: Nineteen patients were treated following the P-LYMA protocol. Patients underwent pre- and postoperative complex decongestive therapy (CDT). A variety of physiologic and excisional procedures were performed, either independently or in combination. The primary outcome was to assess the circumferential reduction rate (CRR). The Lymphedema Quality of Life Score (LeQOLiS), reduction in the number of cellulitis episodes, and complications were recorded. Results: The mean CRR was 73 ± 20% at twelve months postoperatively. The frequency of cellulitis episodes per year decreased from a mean of 1.9 ± 0.8 preoperatively to 0.4 ± 0.6 during follow-up. Two patients experienced minor complications. The mean hospitalization time was 5 days. Patients’ quality of life, as measured by the LeQOLiS, significantly improved from 70.4 ± 12 preoperatively to 24 ± 14 at twelve months postoperatively. Conclusions: The P-LYMA algorithm maximizes surgical outcomes and improves the quality of life in patients with primary lymphedema. CDT is essential for optimizing results.

Publisher

MDPI AG

Reference42 articles.

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4. Lymphoedema: Pathophysiology and classification;Browse;J. Cardiovasc. Surg.,1985

5. Estimating the population burden of lymphedema;Rockson;Ann. N. Y. Acad. Sci.,2008

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