Lymphedema Surgery

A comprehensive overview of lymphedema covering subjects as symptoms, diagnostics, research, causes and pictures
Lymphedema Surgery

Lymphedema surgery

     The surgery is part of the treatment of lymphedema.

     The development of microsurgical techniques of lymphatic and limitations of physical therapy treatment led to indications of increasing numbers in the context of multidisciplinary teams.

Lymphedema surgery techniques Resection

     The lymphedema surgery techniques named Resection was abandoned in its traditional form, not only because of the infectious problems, scarring problems (shrinkage, delayed wound healing, ulceration, etc.) and also a long hospitalization, but also because of the excellent results achieved by physiotherapy.

     In addition, the resection could leave in place a lymph edematous tissue in the back or in the foot or hand, which is landlocked and becomes painful, untreatable.

     It also entailed the resection of the few remaining lymphatic vessels, hampering the work of the physiotherapist.

     Currently, lymphedema surgery covers some excess skin folds on the localized area through non-retraction well managed physiotherapy treatments. These folds cause maceration with a risk of infection, interfering with bandaging and the effective cure.

     Resection is usually simple without plastic surgery and usually it is recommended by the physiotherapist. During this lymphedema surgery, the functional lymphatic channels should be followed .

     Several reasons which make us choose a resection lymphedema surgery:

  • The weight and volume are disabling;
  • Vesicles related to reflux (which exist in 10% of cases from experience) require patients to wear a pad.

     Finally, problems arise with urination and sexuality:

      In men:

  • At the penis: it is practiced the circumcision, sometimes associated with anterior or posterior resection.
  • In case of lymphedema it is very important to make a graft excision (skin grafting semi-thick).
  • At the scrotum: excision-suture wide, identifying the testes and cords, is the single most frequent surgery.
  • The presence of gallbladder (less frequent than in women) requires excision-thin skin graft;

     In women - The therapeutic action is centered on the wide excision vesicles and warts with ligation of the lymphatic channels. The excision of small labia is associated with the circumcision of the clitoris. In this case, the postoperative course is often very simple.

     Currently, the rate of recidivism (always partial) is less than 10%. In these cases an iteratively lymphedema surgery was performed.

B - Diversion lymphedema surgery techniques

     They are all designed to divert the excess lymph within another structure. Two techniques persist: lymphovenous anastomoses, regardless of their anatomical forms and the transfer nodes.

lymphovenous anastomosis

     Indeed, when the lymphatic pressure decreased since it had returned to normal, the flow reversed and the blood coagulated in the lymphatic channels. The good experimental results are not members of lymphoedema. The long-term results are questionable and require further evaluation in progress on subjective and objective reliable criterias, sometimes being difficult to identify and access.

Transfer of vascularized lymph

     A lymph node is removed from the cervical level, inguinal or more recently axillary with its vessels (superficial circumflex vessels, transverse cervical branch of the axillary) and transferred in situ lymphedema. Sometimes, several lymph nodes can be transferred successively in staged in the affected limb. The vessels are connected end-to-side, or end-terminal in the vessels of the arm receiver, to help keep the lymph vascular and therefore the viable lymph pass through the membrane node and join the bloodstream through the venous anastomosis of the ganglion.

     Following the experimental work in rats which showed that the transferred lymph maintain fixation, the clinical study was undertaken. Of more than 100 lymphedema (mainly secondary), the author obtained a clinical improvement in 70% of his patients.

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