Lymphedema is the abnormal accumulation of fluids in the body’s soft tissue resulting in the localised edema (swelling) of the affected tissue. Lymphedema mainly affects the limbs but swelling/bloating in other parts of the body such as face, neck and abdomen is possible.
The lymphatic system is part of the circulatory system and the immune system of the body and consists of lymphatic vessels, lymph nodes, lymphatic organs, and lymphatic tissue. A functional lymphatic system is an important component of the immune system and allows for the flow of a clear fluid known as lymph throughout the body.
Malfunctioning of the lymphatic system may occur if the lymphatic system is damaged by infections, trauma or the treatment of cancer. In the case of patients who have undergone cancer treatment (most commonly breast cancer treatment), symptoms of lymphedema may only manifest a few months or years after treatment.
Lymphedema may also be inherited as a genetic disorder such as Milroy’s disease, Meige’s disease, or as late-onset lymphedema.
Once the lymphatic system is compromised, lymph is no longer able to drain out of the tissue resulting in abnormal accumulation of lymph in tissue. Cellulitis (infection of skin tissue) may also become more frequent due to the malfunctioning immune system.
Signs and symptoms
Common signs and symptoms that indicate you may be suffering from lymphedema include:
- Swelling in the limbs, face, neck or abdomen area
- Discomfort or aching due to swelling
- Restricted movement/mobility issues due to swelling
- Dermal fibrosis; scarring, hardening and thickening of skin tissue
- Frequent infections/inflammation due to compromised lymphatic system
- Abnormal feelings of tightness or heaviness in limbs
- Discolouration of the skin
- Wart like growths on affected tissue
- Thickening of the skin’s epidermis
There are multiple approaches to treating lymphedema and the suitability of the treatment method chosen is determined by type and severity of the patient’s lymphedema.
Intermittent Pneumatic Compression Therapy
A pneumatic pump, also known as an intermittent pneumatic compression pump, is an inflatable garment that is often worn as sleeves on the affected body parts of lymphedema patients.
During intermittent pneumatic compression therapy, a pneumatic sleeve is worn on the affected limb/body part of the patient. Rhythmic inflation and deflation of the pump with compressed air compresses the affected tissue and stimulates the flow of lymph fluid out of the tissue to alleviate swelling.
Depending on the location that the pump is worn on, patients may sit or lay on their backs during treatment.
Intermittent pneumatic compression therapy is not recommended as a standalone treatment for lymphedema as it only alleviates swelling by redirecting lymph away from the affected area and does not correct the lymphatic system. In more serious cases of lymphedema where intermittent compression therapy only is not effective, intermittent compression therapy is often used in conjunction with surgery (such a liposuction surgery) to maintain the size of the surgically corrected limb/tissue.
Accumulation of lymphatic fluid due to lymphedema can cause inflammation of surrounding tissue and stimulate the growth of fat cells, leading to swelling and restriction of movement in the affected area/limb. Affected tissue can be treated by surgical debulking, excess fluid and fat is directly drained via liposuction to alleviate swelling.
During the liposuction procedure, the surgeon will make a small incision in the affected area, a thin tube attached to a specialised vacuum machine would then be inserted into the incision. Fat and excess liquid will be drained from the treatment area via suction from the vacuum machine. Patients will see immediate reduction in tissue volume following a successful liposuction surgery, intermittent pneumatic compression therapy may be used after liposuction as a follow up therapy to maintain post-surgery results.
Liposuction is currently one of the most common and effective ways of managing chronic swelling due to lymphedema.
- Is liposuction suitable for me?
Liposuction is suitable for patients who suffer from widespread fat accumulation in the affected tissue, patients who suffer from late stage lymphedema, or patients who are non-responsive to compression treatment.
Liposuction is also viable for patients who suffer from late stage lymphedema where fibrosis of the tissue is so extensive that physiological treatment may no longer work.
- Benefits of liposuction
Liposuction can immediately and significantly reduce swelling as it directly removes excess liquid and fat from the affected area. This procedure can be used for cases of lymphedema where is swelling is so severe that the affected area is no longer responsive to compression therapy or alternative non-invasive treatments.
In later stages of lymphedema fibrosis of the tissue may be so extensive that physiological treatment techniques may no longer work, liposuction remains as a viable treatment method to alleviate swelling in these patients.
Lymphovenous Anastomosis Bypass Surgery
Lymphovenous bypass, also known as lymphaticovenular anastomosis, is a procedure which attaches a functioning section of a distal lymphatic channel to a nearby vein, allowing lymphatic fluid to bypass malfunctioning sections of the affected lymphatic vessel and drain directly into the recipient vein to correct swelling caused by a malfunctioning lymphatic system.
During the surgery the surgeon will use surgical tools to sever the malfunctioning lymphatic channel, the functional half of the lymphatic channel will then be surgically attached to a recipient vein to create a bypass channel for lymph to drain through. The surgeon will make multiple attachments during the surgery with the aim of establishing several stable bypass channels for long-term alleviation of swelling in the affected area.
- Benefits of lymphovenous bypass
Lymphovenous bypass provides a long-term solution to treating early-stage Lymphedema. This procedure surgically repairs the malfunctioning lymphatic system to allow for the drainage of lymphatic fluid into the vein. Lymphovenous bypass surgery is currently considered to be the gold standard of long-term lymphedema treatment.
- Is lymphovenous bypass surgery suitable for me?
Lymphovenous bypass surgery is suitable for the treatment of early-stage lymphedema. More severe stages of lymphedema may require alternative treatments. Patients who are unresponsive to compression therapy are also suitable for lymphovenous bypass surgery.
Vascularised Lymph Node Transfer
Vascularised Lymph Node Transfer (VLNT) is the surgical transplantation of functional lymph nodes from healthy tissue to areas affected by lymphedema. This procedure fixes the malfunctioning lymphatic system by introducing new functional lymph nodes to the system.
Before the surgery, imaging may be used to identify suitable donor sites on the patients with a high number of healthy lymph nodes. The healthy lymph nodes are collected, usually from patient’s neck, axilla or groin area, and transplanted to affected tissue. Following a successful transplant, new lymphatic channels will grow from the transplanted nodes allowing for normal lymphatic function to be restored and normal lymph drainage to resume.
- Benefits of vascularised lymph node transfer
VLNT is a long-term solution to treating lymphedema as it corrects the malfunctioning lymphatic system via lymph node transplant, this procedure allows the body to grow new lymphatic channels for the drainage of lymphatic fluid from the affected tissue. Following a successful VLNT, the body will be able to regenerate a healthy lymphatic system.
- Is vascularised lymph node transfer suitable for me?
VLNT is suitable for patients who lack lymph nodes. Lymph nodes may sometimes be damaged or removed during cancer treatment, lymphedema is a know side effect of certain cancer treatments and is more common in patients who underwent treatment for breast cancer. VLNT can replace missing lymph nodes in the affected areas to allow patients to regenerate a functional lymphatic system.
VLNT is also suitable as a secondary procedure for patients who are unresponsive to lymphovenous bypass.