Management and Prevention of Lymphatic Complications of Radical Dissections

Groin and axillary lymph node dissections are associated with significant morbidity. Possible complications include lymphangitis, wound dehiscence, lymphocele, hematomas and lymphedema. Secondary lymphedema of the limbs is a debilitating and progressive condition that commonly occurs following melanoma treatment. The technique known as lymphatic microsurgical preventive healing approach (LYMPHA) is able to prevent secondary lymphedema following lymph node dissection. LYMPHA can only be carried out in patients with melanoma of the trunk. From a surgical point of view, it is recommended to perform surgical lymphatic ligatures on cut lymphatic vessels instead of using an electric or bipolar scalpel. Blue dye can be useful in order to visualize the lymphatic vessels and properly close them. Lymphorrhea from the wounds should be always treated initially with compressive dressing. In refractory cases, sclerosing agents can be used or fibrin glue or other synthetic adhesives can be injected. If conservative treatment fails, surgical treatment can be performed. For what concerns lymphedema, non-operative techniques make it possible to control the evolution of the pathology and reduce the stage of already advanced cases. Therapeutic strategies consist of bandages and compression garments. Multiple lymphatic-venous anastomoses have proved to be effective in the treatment of secondary peripheral lymphedema.