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:
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.
The procedure involves harvesting several superficial lymph nodes from the groin area attached to the DIEP flap. The superficial lymph nodes are not responsible for draining the leg and therefore it is unlikely that you would develop lymphoedema of your leg. However, to reduce the risk of donor site lymphoedema even further, we use a video fluoroscopy camera to identify which lymph nodes are important for draining the leg. These important lymph nodes are then avoided to reduce the risk of developing leg lymphoedema.
The lymphoedema begins to improve rapidly and many patients will notice a reduction in the size of their affected limb before discharge from the hospital. However the limb will continue to soften and reduce over the following 18 months. The lymph nodes have been shown to release cytokines (cell signaling chemicals) that encourage old lymphatic pathways to open up and new networks to develop. Most patients will notice reduced discomfort and heaviness in their affected limb. Those suffering from recurrent cellulitis should also notice a reduction in the number of episodes. Depending on the severity and length of time you have had lymphoedema, you may need subsequent procedures such as liposuction or lymphatic venous anastomosis. It is essential to continue to wear your lymphoedema garments and be managed by a lymphoedema nurse as you recover. We have our own lymphoedema nurse who will look after you throughout your time with us. She will liaise with your local team following your discharge.
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.
What is 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. However it is essential that you continue to wear compression garments, as the limb will swell again if compression is not maintained. For patients who have had a lymph node transfer then liposuction is an adjunctive procedure to achieve a final contour. It is possible that compression garments will not be required if the lymph nodes are fully functioning and have resolved the lymphoedema. The assessment of a lymphoedema nurse is essential to the process.
