Lymphedema

Lymphedema is a disorder caused by the accumulation of fluid in the extremities, as consequence of a malfunction of the lymphatic system.

In Europe, the main cause of lymphedema is lymph node resection for breast cancer treatment. Other tumors may also require surgery on the lymph nodes, causing lymphedema.

Lymphedema that occurs as a result of surgeries on lymph nodes is called “secondary lymphedema”.

Another type of lymphedema is “primary lymphedema”. This occurs spontaneously (without prior surgery), is usually hereditary, and develops before the fourth decade of life.

There are four stages of lymphedema according to the physical examination:

• Stage 0: also called subclinical stage. The patient reports heaviness of the arm or leg, although there is no objective increase in its diameter.
• Stage I: accumulation of fluid in the limb, which improves with elevation.
• Stage II: constant limb diameter increase. Does not improve with elevation.
• Stage III: Also called elephantiasis. There is a very large increase in the diameter of the limb and trophic changes (great damage) of the skin.

At any stage, cellulitis (skin and subcutaneous tissue infection), pain, limitation of movement or thickening of the skin in the affected limb may appear.

The diagnosis of lymphedema is made by:

1. Clinical history: temporal correlation between lymph node
   surgery and increased limb size.
2. Lymphography: obtaining radiological images of the lymph
   nodes and vessels by injection of a contrast agent.
3. Indocyanine green: obtaining images of the lymphatic vessels by injecting green dye.

Lymphedema is a chronic disorder with no definitive treatment. However, by combining conservative and surgical treatment we can control the disease and prevent its progression.

1. Conservative treatment: lymphatic drainage, compression garment, balanced diet and physical activity.

2. Surgical treatment, there are different options:

• • Lymphovenous anastomosis (LVA): using microsurgery techniques, the lymphatic vessels are connected to the venous system to facilitate the drainage of the lymphatic fluid. The duration of this procedure depends on the number of anastomoses that can be performed. It usually takes between 1 and 4 hours. The admision to hospital is usually 1 day.Upon discharge you will be able to walk and live a relatively normal life, avoiding exercise during the first 6 weeks. The sutures (stitches) on the skin are removed after 2 weeks.After surgery, you should wear a lightly compressive bandage on the operated limb. After the 5th week, you should start manual lymphatic drainage and wear compression garments. Sun protection is essential at least for the first year.
  • Lymph node transplantation (LNT): using microsurgical techniques, nodes are obtained from another area of the body, and they are transplanted into the affected limb. The duration of this intervention is usually 4-5 hours. The admision to hospital is from 3 to 7 days. Upon discharge you will be able to walk and live a relatively normal life, avoiding exercise during the first 6 weeks.The sutures (stitches) on the skin are removed after 2 weeks. After surgery, you should wear a lightly compressive bandage on the operated limb and start manual lymphatic drainage.You should avoid the massage on the lymph node transfer (armpit or groin). Sun protection is essential at least for the first year.
  • Liposuction of the limb: aspirates fluid and fat from the affected limb.

Not all patients are candidates for surgical treatment. Individual assessment is necessary to know if you are a proper candidate for any of these treatments.

You can contact us through this form, by phone at +34 91 146 59 14, or by email: info@mcplastica.es