Background and Objectives: Lymphedema is an important and underestimated condition, and this progressive chronic disease has serious implications on patients’ quality of life. The main goal of research would be to prevent lymphedema, instead of curing it. Patients receiving radiotherapy after lymph node dissection have a significantly higher risk of developing lymphedema. Through the prophylactic use of microsurgical lymphaticovenular anastomoses in selected patients, we could prevent the development of lymphedema. Materials and Methods: Six patients who underwent prophylactic lymphaticovenular anastomoses in a distal site to the axillary or groin region after axillary or inguinal complete lymph node dissection followed by radiotherapy were analyzed. Patients characteristics, comorbidities, operative details, postoperative complications and follow-up assessments were recorded. Results: Neither early nor late generic surgical complications were reported. We observed no lymphedema development throughout the post-surgical follow-up. In particular, we observed no increase in limb diameter measured at 1, 3, 6 and 12 months postoperatively. Conclusion: In our experience, performing LVA after axillary or groin lymphadenectomy and after adjuvant radiotherapy, and distally to the irradiated area, allows us to ensure the long-term patency of anastomoses in order to obtain the best results in terms of reducing the risk of iatrogenic lymphedema. This preliminary report is encouraging, and the adoption of our approach should be considered in selected patients.

Hidradenitis suppurativa (HS) is a chronic and debilitating disease that primarily affects the axillary, inguinal and anogenital areas. The treatment requires wide surgical excision of the affected tissue with adequate free margins in order to avoid recurrence. However, axillary and inguinal regions reconstruction after HS excision still represents a big challenge; the large defect can be closed using flaps, which allows more rapid rehabilitation and minimizes the risk of later scar contracture. In this report is discussed our experience with reconstruction of severe bilateral hidradenitis lesions of the axillary and inguinal areas in a young woman. Bilateral thoracodorsal artery perforator flaps were used for the axillary reconstruction while profunda artery perforator flap and direct suture were used respectively for left and right inguinal region.