What is lymphedema?
Lymphedema is the collection of lymph fluid that occurs as a result of impaired lymph flow, most commonly in the limbs of the person, depending on congenital or post-operative factors. 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 head cancer.
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 receive 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. In the middle of these treatment periods, the patient continues the compression with special clothes in his normal life. Surgical treatment methods are started to be applied in cases where the benefit of this treatment is decreasing and the edema treatment is no longer fully resolved with these treatments.
Here are a few methods. As one of these treatment systems can be selected according to the clinical condition of the patient, combined treatment methods can also be applied.
Tissue Removal Surgeries
Lymphotic-venous shunt surgery
Vascular lymph node transplantation
Tissue removal surgeries
They are the first surgical processes used in the treatment of lymphedema. Despite the emergence of an aesthetically difficult appearance, it was an alternative surgical technique at first. However, with the use of other formulas in plastic surgery, it started to be applied only in selected patients, which are less preferred. In the clinic, I use this surgical technique in stages, different from the classical method, in selected patients who have lymphedema for a long time and who have a large amount of excess skin and adipose tissue. 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 patients who are not suitable, it will ensure the removal of the fat tissue in the patient, while on the other hand, the lymph channels, which are presumably 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
It is a method in the form of overcoming this clogged area by combining the intact lymphatic vessel channel with a vein with a supermicrosurgical technique before the clogged lymphatic vessels region in these surgeries. 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 I started to see the successful results of this method, which has entered the scientific world in recent years, in 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 are carried to the limb with lymphedema from the other part of the body in a vein, and it is carried 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 after surgery, without any physical therapy or compression. Although it varies from patient to patient in the long period, this volume reduction continues to increase.