• Advances in Treatment of Lymphedema with Plastic Surgery

    by  • July 12, 2013 • Reconstructive Surgery

    Anatomy of the lymph system, showing the lymph vessels and lymph organs including lymph nodes, tonsils, thymus, spleen, and bone marrow. Lymph (clear fluid) and lymphocytes travel through the lymph vessels and into the lymph nodes where the lymphocytes destroy harmful substances. The lymph enters the blood through a large vein near the heart. (Courtesy the National Cancer Institute)

    Lymphedema is a condition of fluid retention and tissue swelling which is commonly seen in the arms or legs after having lymph nodes removed in the setting of various types of cancers.  When lymph nodes are removed, the drainage of fluid is blocked causing the fluid to collect in the lymphatic vessels which is seen as swelling of the arm or leg.  Breast cancer and melanoma are the most common cancers associated with the development of lymphedema involving the arms and hands while gynecologic cancers and melanoma may result in lymphedema of the legs.  The incidence of lymphedema has decreased with the use of sentinel lymph node biopsies compared to complete lymph node dissections.  Radiation treatment can also potentially increase the risk of developing lymphedema.

    Previously the only management of lymphedema involved wearing compression garments with range of motion exercises and massage therapy.  For those patients that develop severe lymphedema despite these conservative treatments, the only option in the past was radical surgery with removal of the swollen tissues which was extremely painful and disfiguring.

    Fortunately there have been several new advances in the treatment of lymphedema over the past several years.  These techniques have been pioneered in Europe and Asia and are only performed in a few centers in the United States.  Even though these techniques have only been in existence for a few years, the results are extremely promising with the vast majority of patients reporting improvement in their lymphedema.

    The first option is lymphatico-venous bypass surgery which involves reconnecting the lymphatic vessels to small blood vessels within the affected arm or leg.  This enables the fluid that has accumulated in the lymphatic vessels to drain into the blood vessels.  As the fluid drains into the blood vessels, the swelling decreases.  The second option is performing lymph node transfers where lymph nodes are taken from another part of the body and moved the affected arm or leg.  These new lymph nodes replace the ones that were removed and improve the lymphedema.

    Both of these surgeries are available here at Fox Chase Cancer Center with the Division of Plastic and Reconstructive Surgery.  Fox Chase Cancer Center also has a Lymphedema Clinic with specialists who are specifically trained to treat patients with lymphedema.