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.