Learn More About Lymphoedema & The Wide Range Of Surgical & Support Services We Offer ...
Lymphoedema is a chronic progressive condition that results in excessive accumulation of protein-rich fluid in the tissues. This is caused by transport failure in the lymphatic system.
Types Of Lymphoedema
Lymphoedema is classified as primary or secondary lymphoedema. Primary lymphoedema is caused by a developmental problem with the lymphatic system and is often inherited. Secondary lymphoedema however is caused by damage to the lymphatics by a disease or surgical treatment and is the most common type of lymphoedema.
Primary Lymphoedema (rare)
Symptoms Of Lymphoedema
Lymphoedema in most cases is diagnosed clinically based on signs and symptoms. You may be at higher risk of Lymphoedema in some instances such as having had prior or recent cancer treatment, especially involving lymph node biopsy or clearance surgery, or radiotherapy to lymph nodes.
In some cases, certain imaging tests are required to make the diagnosis of Lymphoedema. The gold standard test is Indocyanine Green (ICG) Lymphography which not only helps us in confirming the diagnosis of lymphoedema but is also invaluable to the patient, their lymphedema therapist and surgeon in planning conservative and surgical treatment options based on the condition of the lymphatic vessels and the drainage patterns.
Other imaging modalities such as CT, MRI, radionuclide lymphoscintigraphy are sometimes also utilised.
At PRSM we have a holistic approach to ICG mapping which includes the patient, therapist and treating physicians and surgeons in the process in order achieve optimal treatment outcomes. Please refer to the ICG mapping menu on our approach to ICG Mapping below.
ICG Lymphatic Mapping
The gold standard method of assessing your lymphatic vessels is to have a ICG Lymphography test to map the lymphatic vasculature to understand the degree of lymphatic abnormality and to allow accurate decision making about the treatment options available to your lymphoedema specifically.
Dr Prasad performs this test in the rooms at a separate consultation and will provide you with an immediate view of the lymphatics in your affected limb, and for comparison always performs the same test in the unaffected limb at the same time. This test is recorded in real time and you are provided with a copy of the lymphatic mapping test to take home.
Aims of Lymphoedema Surgery
Depending on whether the affected limb is predominantly fluid or fat determines which lymphoedema surgical procedure is optimal for the patient. Supermicrosurgical or Microsurgical procedures are performed when the limb is predominantly fluid in nature. Super microsurgery is anastomosis of vessels smaller than 0.6mm in diameter. Size of lymph vessels in LVA surgery is usually between 0.3-0.5mm in diameter.
Liposuction is performed when the affected limb is predominantly composed of fatty tissue.
Lymphaticovenous Anastomosis is an extremely specialised and time consuming procedure that requires high levels of surgical expertise.
The lymph vessel is bypassed to a nearby vein restoring the lymph flow back to the venous system. Surgery is performed under high magnification (x35). The patient is usually able to return home the following day after surgery.
Typically 2-3 LVAs are performed per limb.
When is LVA Surgery offered?
Lymph Node Transfer
Lymph nodes may act as a sponge to absorb lymphatic fluid and direct it to the blood vessels. Lymph nodes are harvested (usually from the axilla, groin or neck) and these are used to replace the damaged lymph nodes. Transferred nodes may induce growth of new lymphatic vessels in 12-18 months.
Is there a risk of developing lymphoedema after lymph node transfer?
Reverse Lymphatic Mapping is utilised to prevent lymphoedema of the donor limb after lymph node harvest. Lymphoscintigraphy (nuclear medicine scan) is performed to identify lymph nodes draining the donor limb. These lymph nodes are preserved in lymph node harvest, thus preventing lymphoedema of the donor limb.
In Lymphoedema, excess limb volume without pitting oedema equates to excess fatty tissue. Conservative treatment and microsurgical procedures cannot remove excess fatty tissue.
Excess fat can be removed by liposuction to restore the form and function of the limb. Lifelong use (23.5 hours/day) of custom-made compression garments is mandatory for maintaining the effect of surgery.