Lymphoedema
Lymphoedema is characterised by swelling of certain parts of the body, caused by problems with the lymphatic system. Any part of the body can be affected by lymphoedema, but it tends to target the arms and legs.
Normally, fluid and proteins leak into the body tissues regularly from the blood. This tissue fluid bathes the cells, supplies them with nutrients and clears any old products of metabolism.
The lymphatic system is a network of tubes throughout the body that drains this fluid from tissues and empties it back into the bloodstream. When this system is not working properly, lymphoedema can occur.
Patients who have undergone surgery and radiotherapy for treatment of cancer are particularly susceptible to lymphoedema of the arms or legs and, sometimes, the abdomen or suprapubic area.
Some patients are born with structural problems of the lymphatic system. The vessels may pump sluggishly or there may be insufficient numbers of vessels, or both may occur. Primary lymphoedema may be present before birth (congenital lymphoedema) or may develop during puberty (lymphoedema praecox) or middle age (lymphoedema tarda).
For those patients who have a structural problem with the lymphatic system, the risk of developing a secondary lymphoedema overlying it is higher if they have surgery or radiotherapy for cancer treatment or other surgeries.
There are several surgical options to improve lymphoedema. These include:
Liposuction for Lymphoedema
Liposuction is a surgical procedure for removing fat. In patients with longstanding lymphoedema there are often fatty changes in the limb, which become resistant to compression garments and manual lymphatic drainage. Liposuction can remove these fatty deposits permanently. When performed alone, liposuction will result in immediate reduction in the size of the limb.
Lymphaticovenous Anastomosis (LVA)
Lymphaticovenous Anastomosis (LVA) describes a method of directly connecting the lymphatic vessels in the affected area of the body to the tiny veins nearby. This allows the excess lymphatic fluid to drain directly into the vein and be returned to the body’s natural circulation.
VLNT
Lymph node transfer is a relatively new procedure, which is proving to be very successful in the management of lymphoedema as a result of surgical removal of lymph nodes during breast cancer treatment. It was originally described by French plastic surgeon, Corinne Becker, and has shown to be of great benefit to patients plagued by lymphoedema. I am one of a few surgeons in Europe offering this technique and so far have had very promising results to date with several years follow up.
Lymphatic Imaging (PDE Video Fluoroscopy)
PDE video fluoroscopy uses Indocyanine green (ICG) dye which is injected into the web spaces between your toes or fingers. ICG is a water-soluble dye that fluoresces when exposed to near-infrared (NIR) light.
Video fluroscopy has been used for many years in medicine for different purposes and more recently it has proved to be an important modality in lymphatic imaging.
LYMPHA
Patients who are planned to have removal of lymph nodes as part of their cancer treatment are at a relatively high risk of developing swelling of the arm due to the disruption of the lymphatics and removal of the draining lymph nodes (lymphoedema). Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) concentrates on repairing the cut lymphatics at the time of surgery to reduce the risk of ever developing lymphoedema.
