Lymphology

Lymphoedema is a condition characterised by an accumulation of fluid (lymph stasis) in a body part, most commonly in the legs or arms. This condition, if not correctly diagnosed, gets progressively worse over time.

Lipedema, unlike Lymphoedema, is a chronic and progressive, painful and highly disabling pathology of the adipose (fat) tissue, characterised by an inflammatory process that promotes the accumulation of fat in multiple body areas (mainly in the lower limbs).

Lymphoedema and Lipedema can coexist and, in this case, the condition is called Lipo-Lymphoedema.

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Causes

Lymphoedema can be primary congenital if it is present at birth, primary early if it occurs before the age of 35 or primary late if it appears later. Primary Lymphoedema has genetic causes and presents lymphatic malformations of varying degrees involving lymph nodes and lymphatic vessels.
Lymphoedema is defined as secondary when related to a triggering cause, for example when it arises after treatment of a tumour (removal of lymph nodes, radiotherapy) or after a traumatic event.
Lipedema, on the other hand, has genetic and hormonal causes, affects the female sex and is characterised by an abnormal proliferation of adipose tissue.

Diagnostic

Lymphoedema is first diagnosed by a thorough clinical examination by a specialist physician. The performance of specific instrumental examinations then allows the correct therapeutic approach to be assessed:

Lymphoscintigraphy,
Indocyanine Green Fluorescein Micro-Lymphography,
high-resolution ultrasound examination.

Lipedema differs from lymphoedema in specific clinical aspects and can be correctly diagnosed during a specialist examination. If a lymphatic stasis coexists, performing a Lymphoscintigraphy and/or Fluorescein Indocyanine Green Micro-Lymphography allows the best therapeutic course to be set.

Traitements

Lymphoedema and lipedema can be treated advantageously in an integrated manner with conservative therapies and surgery. Both pathologies, once correctly diagnosed, initially find great benefit with conservative therapy (manual lymph drainage, mechanical lymph drainage, multi-layer functional bandaging, elastocompression). The indication for surgery is then assessed and proposed to patients in relation to the specific clinical condition.

Surgery and microsurgery for the treatment of Lymphoedema, Lipedema and Lipo-Lymphoedema offer excellent results with minimally invasive techniques. In the case of Lymphoedema and Lipo-Lymphoedema, the lymph stasis is first treated using reconstructive approaches (Lymphatic-Venous Microsurgery, Reconstruction of the Superficial and Deep Lymphatic System). Subsequently, adipose, fibrotic and inflammatory tissue is removed using modern Fibro-Lipo-Aspiration techniques that preserve the lymphatic system.

Lipedema, on the other hand, is effectively treated surgically by minimally invasive aspiration of the accumulated adipose and inflammatory tissue in the affected areas, again preserving the lymphatic system with dedicated techniques.

Post-traitements

The effect of conservative therapies progressively brings great benefit to the patient. As far as surgery is concerned, being minimally invasive procedures, recovery is rapid. Lymphoedema, Lipedema and Lipo-Lymphoedema are pathologies that should not be neglected, but rather appropriately treated in an integrated and multidisciplinary manner, as early as possible. However, excellent results are also obtained in the more advanced stages of these conditions.