Lymphedema

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Lymphedema is a long-term condition characterized by swelling of the extremities (arms and/or legs) due to build-up of lymph fluid in these areas. The extra fluid accumulates because your lymphatic system (lymphatic channels and/or lymph nodes) has been damaged and is unable to drain the excess fluid effectively back into the blood-stream. Over time, the protein-rich lymph fluid causes excessive fat and tissue build-up at the affected areas, which further increases the size of the limb and pressure on the lymphatic drainage. This contributes to progressive worsening of the condition if left untreated.

Any problem that blocks the drainage of lymph fluid can cause lymphedema. This includes damage of the draining channels due:

• Previous surgery
• Radiotherapy
• Trauma
• Infection

Lymphedema features can range from mild, intermittent swelling, to persistent swelling with gross skin changes.  Mild cases of lymphedema may experience heaviness of the affected limb, aching, and increase in limb size. Severe cases of lymphedema can affect the ability to move the affected limb, increase the risks of skin infection and sepsis, and lead to skin changes and recurrent wounds over time.

Treatment

Unfortunately, lymphedema is a condition that causes irreversible damage to your lymphatic system. There is no cure for lymphedema and treatment aims to alleviate symptoms and severity of the condition. 

The cornerstone of lymphedema treatment is control of the degree of limb swelling with limb massage and regular compression (by means of bandaging, stockings or specialized pumps). Careful skin care with attention to hygiene and regular moisturizing is crucial to keep the affected skin smooth and supple, to reduce the risk of skin tears and infection.

In selected patients who continue to experience symptoms despite compliance with the above measures, surgery may be offered to:

1.  Reduce limb size, volume and weight:

• Liposuction: This removes excess fatty tissue that has accumulated over time to help to lighten the limb and make movement easier
• Removal of excess tissue: For severe lymphedema cases, hardened bulky tissues have to be excised completely in order to reduce limb size. This is a relatively major procedure which can lead to substantial blood loss, and may have to be staged depending on the volume of tissues that have to be removed.

2.  Improve lymphatic drainage:

• Lympho-venous bypass: Through microsurgery, remaining functional lymphatic channels can be diverted away from blocked areas into nearby veins to allow the lymph fluid to enter the blood-stream directly. This is a technically difficult operation due to the size of vessels involved (0.5 - 1mm). Multiple connections need to be created to result in a significant clinical improvement reduction. This procedure cannot be performed in more advanced stages of lymphedema when there are no longer any functioning lymphatic channels.
• Lymph node transfer: Lymph nodes can be harvested from selected areas of the body (e.g. neck, groin, abdomen) and surgically implanted in the affected limb. When successful, the new nodes can help to rebuild new lymphatic channels and resorb excess lymphatic fluid to reduce congestion of the limb.

It is important to note that none of the above options can cure lymphedema completely. Regardless of whether or not surgery is performed, you will still need to continue with regular massage, strict compression, and good skin care to maintain your results and prevent relapse of the condition.

Because the earlier stages of lymphedema are easier to control and respond better with surgical intervention, it is important to consult with a plastic surgeon early if you feel you may have lymphedema.