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Lymphedema Surgery

Lymphedema is a condition characterized by painful swelling in the extremities (arms and/or legs. It is caused by the accumulation of protein-rich lymph fluid in the skin and underlying fat tissues. The condition most commonly affects the lower limb and upper limb, and seldom the other parts of the body.

The various causes of lymphedema are

Congenital – Problems in the lymphatic system by birth

Infection – Filariasis/ Elephantiasis

Post-Surgery– Lymph nodes serve as a defense against the spread of cancer in that particular region. Hence the lymph nodes are generally excised along with the cancer surgery. This leads to lymphedema in the drainage basin of the lymph nodes. For example, hand swelling after breast cancer surgery, and lower limb lymphedema after cervical cancer surgery.

In developing countries like India, secondary causes like infection and cancer surgery are common.

Symptoms of Lymphedema (: remove the colon)

Lymphedema initially starts as a mild swelling that subsides on limb elevation. The stasis of the protein-rich lymph fluid in the skin will induce fibrosis and thickening of the skin. The severity gradually increases and the swelling becomes permanent. They also cause frequent infections or discharge from the limbs and ulcers in the foot. This is a chronic debilitating condition, which could lead to huge swelling and restrict the function of limbs. Such a stage with large legs with thickened skin is called “Elephantiasis”. The limb becomes deformed and affects ambulation.

Lymphedema was once considered an incurable disease. A better understanding of the lymphatic system and the advancement in microsurgery has brought many solutions to this problem, which could make the patient near normal.

Once the diagnosis of lymphedema is established, nonsurgical treatment is initiated as soon as possible In the early stages, non-surgical options prevent/delay the progress of the lymphedema. These treatments, although beneficial, can be burdensome to patients and require a lifelong commitment.

The different conservative measures are

  • Skin care
  • Prophylactic Antibiotics
  • Manual lymphatic drainage (MLD)
  • 3 layer / 4 layer compression dressing

Lymphatic pump
Surgery for lymphedema may be appropriate when nonsurgical therapy is inadequate to control the symptoms.

The various surgical procedures described , depending on the stage of lymphedema are

  • Debulking surgery including Liposuction
  • NodoVeno shunt-lymphatic vessels are connected and drained into the body’s venous system
  • Vascularized lymph node transfer- lymph nodes are harvested from one part of the body and surgically implanted in the affected area to rebuild a failed system.
  • LymphovenousAnastamosis – this is a supermicrosurgery technique which bypasses the lymphatic flow obstruction by connecting the lymphatics to the superficial veins
  • The surgical / nonsurgical options are chosen based on the stage of lymphedema, site, duration of the problem and the skin quality . the non surgical methods are generally advised to continue even after the surgery.

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