What is Surgical Treatment for Lymphedema?

Dr. Ketan Patel (Keck School of Medicine of USC, Department of Surgery)Lymphedema is a relatively common side effect of radiation therapy and oncologic surgery. This condition, in which lymph fluid does not flow as efficiently as it once did due to lymph node removal, can cause debilitating swelling in the arms or legs. Lymphedema in the arm is commonly related to breast cancer treatment in which axillary lymph node dissection or radiation occurred. Lower extremity lymphedema may occur after treatment for gynecological, prostate, or bladder cancer treatment in which pelvic lymph node dissection or radiation occurred. Though cancer treatments may have been generally successful, the accumulation of lymph fluid in tissues can be a frustrating problem.

Some studies suggest that, when lymphedema treatment begins right away, swelling may resolve with only exercise, compression, and lymphatic drainage massage performed by a lymph specialist. Using these modalities for mild lymphedema, a patient may achieve lasting improvements within 6 months. However, there are cases in which lymphedema surgery is necessary. Lymphovenous bypass and vascularized lymph node transfer are two common surgical techniques performed by lymphedema specialists.

What are lymphovenous bypass and vascularized lymph node transfer?

Lymphovenous bypass surgery is a technique a surgeon performs to bypass obstructed lymphatic vessels. This surgery restores lymph flow by connecting the obstructed vessels to adjacent veins. Patients who undergo this bypass technique during early-stage lymphedema tend to achieve lasting benefits from treatment.
Vascularized lymph node transfer is an intricate procedure in which the surgeon transplants healthy lymph nodes from another part of the body into a vascularized flap in the affected region. This transfer provides a permanent new pathway for lymph drainage to occur. However, it can take several months for the new drainage system to be fully functional.

What about debulking?

Debulking or ablative techniques have been commonly performed to address lymphedema since the early 20th century. Early on, doctors performed radical excisional procedures to remove swollen tissue. Over time, techniques became more conservative, evolving to liposuction. Lymph node sparing liposuction continues to be an effective method of reducing limb volume, but it is not “fix;” it does not redirect lymph flow so that swelling does not recur.
Early and consistent treatment for lymphedema is ideal. When surgery is necessary, each patient of our Glendale office can expect to receive a treatment plan customized to their needs. To learn more about surgery for lymphedema, call 323-442-0416.

Posted in: Lymphedema Surgery

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