What is Lymphedema?
Lymphedema is the collection of lymph fluid that occurs as a result of impaired lymph flow in the limbs such as the arm and leg, depending on factors such as congenital or subsequent surgery. The most common cause of subsequent lymphedema is the removal of the main lymph nodes of the limbs as a result of breast cancer or a cancer to the head.
Stages of Lymphedema
Initially, lymph fluid accumulates in the affected limb. Edema in the extremity is relatively soft. However, over the years, this accumulated lymph fluid increases the fat storage under the skin in the limb. Meanwhile, the edematous limb becomes harder. At the last stage, this accumulated lymphatic fluid also thickens the skin structure and creates cracks, and the frequent attacks of infection, called lymphangitis, are stuck in the limb. Therefore, the patient must be hospitalized frequently and receive long-term antibiotic therapy.
Lymphedema Treatment Stages
Treatment principles are divided into two main parts as surgical and non-surgical.
Nonsurgical Treatment Physical
therapy, including compression therapy and massage, is applied to the patient’s limb. Compression and massage therapy tries to drain the accumulated lymph fluid. The patient continues the compression in his normal life with special clothes between these treatment periods. Surgical treatment methods are started to be applied in cases where the benefit of this treatment is reduced and edema treatment cannot be completely resolved with these treatments.
There are several methods here. Depending on the clinical condition of the patient, one of these treatment methods can be chosen or combined treatment methods can be applied.
- Tissue Removal Surgery
3.Lymph and vein joining operations (Lymphotic-venous shunt)
- Vascular lymph node transplantation
Tissue Removal Surgery
They are the first surgical procedures used in lymphedema treatment. Although an aesthetically difficult appearance emerged, it was an unprecedented surgical method in the early days. However, with the use of other methods in plastic surgery, it was started to be used in less preferred and only selected patients. I in the clinic I have been using this surgical technique gradually, different from the conventionally defined method, in patients with long-term lymph edema and excessive excess skin and adipose tissue in selected patients. I then apply it to my vascular lymph node transplant patients.
Although it has been used more frequently in recent years, I choose my patients very carefully in my clinical practice. In my opinion, if liposuction is performed in patients who are not suitable, it will ensure the removal of adipose tissue in the patient, and on the other hand, perhaps the remaining intact lymph channels may also be damaged. For this reason, I also use liposuction surgery for patients who do not accept vascular lymph nodes or tissue removal surgery.
Lymph and Vein Combination Surgeries
In these surgeries, before the blocked lymph vessels area, the intact lymph vessel channel into a vein Combining with super microsurgical technique, it is a method of overcoming this occluded area. Super microsurgical technique With its definition in the scientific world, this surgical method has made a breakthrough in the treatment of lymphedema microsurgery.
Schematic Lymphatic Vascular and Vein Anastomosis
I use this method alone on very rare patients. Combined with vascular lymph node transplantation, I think this method gives very successful results in suitable patients.
Vascular Lymph Node Transplant
After I started to see the successful results of this method, which entered the scientific world in recent years, in national congresses, I started to apply this method in many patients as the first method in lymphedema surgery. In this method, the lympheded limb is transported from elsewhere in the body to the veins of that limb by microsurgical techniques by transporting the lymph nodes with vessels.
In my patients for whom this technique is suitable, I see an average of 30% decrease in the limb volume in the first month without any physical therapy or compression. Although it varies from patient to patient in the long term, the increase in this volume reduction continues.
As a result;
I recommend surgical interventions in which one or more operations are performed in combination according to the history, age, agent and tissue condition of the edematous limb of my patients with lymphedema.