Abstract
Lymphoedema is a chronic debilitating disease of the lymphatic system that occurs due to either abnormal development or damage of the lymphatics resulting from cancer or infection. The optimal treatment of lymphoedema is still elusive. Management is tailored according to clinical features, investigations and expectations of each patient. Lymphoedema patients should undergo a trial of conservative management with compression therapy, manual lymphatic drainage and external sequential compression devices. Early lymphoedema is treated by lymphovascular anastomosis, where the lymph vessels are connected to the subdermal veins by supermicrosurgery. In late cases when the limb is fibrotic, vascularised lymph node transfers are done, where lymph nodes are transferred from a healthy area to the affected area. In advanced cases, when the limb is fibrotic with cutaneous folds and skin changes, surgical debulking is done. In lymphoedema, along with accumulation of lymphatic tissue, there is also fat deposition, which can be removed by liposuction. One should be conversant with all treatment modalities to provide the lymphoedema patient with optimal care.
Highlights
Lymphoedema is a chronic debilitating disease of the lymphatic system that affects more than 250 million people worldwide[1]
Patients with early-stage lymphoedema benefit from physiological procedures such as lymphovenous anastomosis (LVA), where the lymphatics are connected to the veins or by vascularised lymph node transfers (VLNTs), in which lymph nodes from one part of the body are transferred to the affected area to drain excess lymphatic fluid
Saaristo proposed that high levels of vascular endothelial growth factor C is produced by the transferred lymph nodes which induces lymphangiogenesis and facilitates recanalisation of the lymphatic vessels between the recipient and transferred lymph nodes[25]. These theories probably explain why VLNTs are transferred to proximal levels in the limbs. This is best illustrated by the case of using the deep inferior epigastric perforator (DIEP) flap along with the lymph nodes in the groin to treat post-mastectomy lymphoedema
Summary
Lymphoedema is a chronic debilitating disease of the lymphatic system that affects more than 250 million people worldwide[1]. Patients with early-stage lymphoedema benefit from physiological procedures such as lymphovenous anastomosis (LVA), where the lymphatics are connected to the veins or by vascularised lymph node transfers (VLNTs), in which lymph nodes from one part of the body are transferred to the affected area to drain excess lymphatic fluid. These theories probably explain why VLNTs are transferred to proximal levels in the limbs This is best illustrated by the case of using the deep inferior epigastric perforator (DIEP) flap along with the lymph nodes in the groin to treat post-mastectomy lymphoedema. Many patients with filarial lymphoedema and severe lymphoedema have many skin changes that are best treated by surgical debulking in the limbs Microsurgical procedures such as LVA and VLNTs are generally beneficial in the early stages of the disease, when the lymphatics are relatively healthy and when the tissues are still soft and pliable. We will look at the different excisional techniques in detail
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