Matching primary with secondary lymphedemas across lymphatic surgery in genoa (italy) from 1973 until time of covid-19

Authors report their pluridecennial activity (from 1973 up to today) of research, clinical experience and development of lymphatic surgery in Genoa-Italy, in close collaboration with the worldwide centers of the International Society of Lymphology. Five thousand forty-six cases of patients affected by upper and/or lower limbs, primary and secondary lymphedemas and elephantiasis, between 1973 and 2020 underwent lymphatic microsurgery; and between 2012 and 2020, fibro-lipo-lymph-aspiration, according to lymph vessel sparing procedure (FLLA-LVSP), for latest stages of lymphedema/elephantiasis, previously treated by lymphatic microsurgery with partial improvement of the disease. In addition, also morbid obesity related elephantiasis, lipolymphedema/elephantiasis, chylous-lymphatic dysplastic gravitational reflux with complex related syndromes, were treated by tailored surgical procedures, properly combined with tailored medical and nutritional regimens. All patients were followed-up for a minimum of 5 years to over 20 years. Over 96% of patients with earlier stages of disease (initial lymphedema: Stage IB and increasing lymphedema: Stage IIA) progressively stopped using conservative therapies; and over 80% of patients with later stages (column shaped limb fibrolymphedema: Stage IIB, properly called elephantiasis: Stage IIIA, and extreme elephantiasis: Stage IIIB), significantly decreased the frequency of physical therapies and discontinued compressive garments or stockings. Dermato-lymphangio-adenitis attacks considerably reduced by over 95%. Staging-guided treatment of peripheral lymphedema, according to authors' Genoa protocol, carries out not only the best long-lasting treatment, but also the contextual target of primary (to avoid lymphatic injuries), secondary (early-stage treatment), and tertiary (late-stage treatment) prevention in the potential worsening of the disease.