Lymphedema refers to swelling that generally occurs in one of your arms or legs. Sometimes both arms or both legs swell. Lymphedema is most commonly caused by the removal of or damage to your lymph nodes as a part of cancer treatment. It results from a blockage in your lymphatic system, which is part of your immune system. The blockage prevents lymph fluid from draining well, and the fluid buildup leads to swelling.

There’s no cure for lymphedema. But it can be managed with early diagnosis and diligent care of your affected limb.

Lymphedema signs and symptoms, which occur in your affected arm or leg, include:

  • Swelling of part or all of your arm or leg, including fingers or toes
  • A feeling of heaviness or tightness
  • Restricted range of motion
  • Aching or discomfort
  • Recurring infections
  • Hardening and thickening of the skin (fibrosis)

The swelling caused by lymphedema ranges from mild, hardly noticeable changes in the size of your arm or leg to extreme changes that make the limb hard to use. Lymphedema caused by cancer treatment may not occur until months or years after treatment.

Treatment of lymphedema

There’s no cure for lymphedema. Treatment focuses on reducing the swelling and controlling the pain. Lymphedema treatments include:

  • Exercises. Light exercises in which you move your affected limb may encourage lymph fluid drainage and help prepare you for everyday tasks, such as carrying groceries. Exercises shouldn’t be strenuous or tire you but should focus on gentle contraction of the muscles in your arm or leg. A certified lymphedema therapist can teach you exercises that may help.
  • Wrapping your arm or leg. Bandaging your entire limb encourages lymph fluid to flow back toward the trunk of your body. The bandage should be tightest around your fingers or toes and loosen as it moves up your arm or leg. A lymphedema therapist can show you how to wrap your limb.
  • Massage. A special massage technique called manual lymph drainage may encourage the flow of lymph fluid out of your arm or leg. Be sure to have it done by someone specially trained in the technique.
    Massage isn’t for everyone. Avoid massage if you have a skin infection, active cancer, blood clots or congestive heart failure. Also avoid massage on areas of your body that have received radiation therapy.
  • Pneumatic compression. A sleeve worn over your affected arm or leg connects to a pump that intermittently inflates the sleeve, putting pressure on your limb and moving lymph fluid away from your fingers or toes.
  • Compression garments. Long sleeves or stockings made to compress your arm or leg encourage the flow of the lymph fluid out of your affected limb. Wear a compression garment when exercising the affected limb.
    Obtain a correct fit for your compression garment by getting professional help. Ask your doctor where you can buy compression garments in your community. Some people will require custom-made compression garments.
  • Complete decongestive therapy (CDT). This approach involves combining therapies with lifestyle changes. Generally, CDT isn’t recommended for people who have high blood pressure, diabetes, paralysis, heart failure, blood clots or acute infections.
Surgical treatment of lymphedema
Δρ. Σταμάτης Σαπουντζής - Πλαστικός Χειρούργος
Pic1. Example of vascularized lymph node transfer for lower extremity lymphedema. The donor site of the nodes are the neck or the groin area and transferred to the leg.

Vascularized lymph node transfer is a procedure where carefully selected lymph nodes are removed from another part of the body and transferred to the limb with lymphedema. Depending upon whether the upper or lower extremity is affected, the lymph nodes may be transferred to the armpit (referred to as the axilla) or the groin, although sometimes they are transferred to the wrist or ankle. Once the lymph nodes are transferred, the blood vessels that supply them are reattached to blood vessels in their new location. This keeps the lymph nodes alive and allows them to reintegrate into the body and help restore a properly functioning lymphatic system. This may help to drain excess fluid from the limb.

Δρ. Σταμάτης Σαπουντζής - Πλαστικός Χειρούργος
Pic.2 Dr. Stam with Prof. Chen in Taiwan

The first report of vascularized lymph node transfer in experimental model was done in 1990 by prof. Hung Chi Chen. Dr. Stam is specialized in lymph node transfer as he has been trained for 2 years by prof. Chen in Taiwan. He has published more than 10 studies about this technique in international plastic surgery journals and conferences

The most common donor site for lymph nodes is the groin, and the procedure will leave a scar that can be hidden beneath underwear or a bathing suit. Usually a patch of skin will be transferred with the lymph nodes so that the their viability can be monitored postoperatively. The surgery will last approximately four to six hours and is performed in the hospital under general anesthesia. Due to the scar release during the procedure, some patients will feel relief of some of their symptoms immediately after surgery. In a period of weeks to months, patients may experience reductions in limb volume, decreased dependence on complete decongestive therapy, and improved quality of life.

Δρ. Σταμάτης Σαπουντζής - Πλαστικός Χειρούργος
Pic3. Female patient before and after vascularized lymph node transfer for left leg lymphedema.

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