What is lymphedema?
Lymphedema is the collection of lymph fluid that occurs as a result of impaired lymph flow, most commonly in limbs such as arms and legs, depending on factors such as congenital or subsequent surgery. The most common cause of subsequent lymphedema is removal of the main lymph nodes of the limbs as a result of breast cancer or a cancer to the head.
Stages of Lymphedema
lymphedema ; Initially, lymph fluid accumulates in the affected limb. Edema in the extremity is relatively mild. However, as the years pass, this accumulated lymph fluid increases the storage of fat under the skin in the limb. Meanwhile, the edematous limb becomes more rigid. In the last stage, this accumulated lymph fluid thickens in the skin structure, creates cracks, and due to this, frequent recurrent infection attacks called lymphangitis are stuck in the limb. Therefore, the patient must be hospitalized frequently and take long-term antibiotic therapy.
Stages of Lymphedema Treatment
Treatment principles are divided into two main parts as surgical and non-surgical.
Physical therapy including compression therapy and massage is applied to the patient’s limb. With compression and massage therapy, drainage of the accumulated lymph fluid is attempted. The patient continues the compression with special clothing in his normal life between these treatment periods. In cases where the benefit of this treatment has decreased and the edema treatment cannot be completely resolved with these treatments, surgical treatment methods are now applied.
Here are a few methods. Depending on the clinical condition of the patient, one of these treatment methods can be selected or combined treatment methods can be applied.
Tissue Removal Surgeries
Lymphotic-venous shunt surgery
Vascular lymph node transplantation
Tissue removal surgeries
They are the first surgical procedures used in the treatment of lymphedema. Although an appearance that is difficult to accept aesthetically, it was an alternative surgery method in the early days. However, with the use of other methods in plastic surgery, it was started to be applied only in selected patients, which are less preferred. In the clinic, I use this surgical technique in a different way than the classical method defined in selected patients who have lymphedema for a long time and an excessive amount of excess skin and adipose tissue due to this. Then I apply it to my vascular lymph node transplant patients.
Although it is a more frequently used method in recent years, I choose my patients very carefully in my clinical practice. In my opinion, if liposuction is performed on unsuitable patients, it will enable the removal of fat tissue in the patient, while on the other hand, the lymph channels that may have remained intact will also be disrupted.
For this reason, I use liposuction surgery for my patients who do not accept vascular lymph node or tissue removal surgery.
Lymph and vein fusion surgeries
In these surgeries, it is a method of overcoming this clogged area by combining the intact lymphatic vessel channel with a vein with a supermicrosurgical technique before the area of the clogged lymphatic vessels. With the definition of the supermicrosurgical technique in the scientific world, this surgical method broke new ground in the microsurgery treatment of lymphedema.
Schematic Lymph Vessel and Vein Anastomosis
Anastomosis schematic view (yellow lymph vessel and blue vein)
I very rarely use this method alone on my patients. I think that this method, combined with vascular lymph node transplantation, gives very successful results in suitable patients.
Vascular lymph node transplantation
After seeing the successful results of this method, which has entered the scientific world in recent years, at national congresses, I started to apply this method as the first method in many of my patients in lymphedema surgery. In this method, lymph nodes from another part of the body are transported to the lymphedema limb with vessels, and they are transported to the vessels of that limb with microsurgical techniques.
In my patients for whom this technique is suitable, I see a 30% decrease in limb volume in the first month without any post-operative physical therapy or compression. Although it varies from patient to patient in the long term, this volume reduction continues to increase.