What is Lymphedema?
Lymphedema is the accumulation of lymph fluid that occurs as a result of disruption of lymph flow in a person's limbs, most commonly in the arms and legs, due to 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 another cancer.
Lymphedema Stages
Lymphedema; Initially, lymph fluid accumulates in the affected limb. The edema occurring in the extremities is relatively mild. However, as the years pass, this accumulated lymph fluid increases fat storage under the skin in the limb. Meanwhile, the edematous limb becomes harder. In the final stage, this accumulated lymph fluid thickens the skin structure and creates cracks, resulting in frequently recurring infection attacks called lymphangitis in the limb. For this reason, the patient needs to be hospitalized frequently and receive long-term antibiotic treatment.
Stages of Lymphedema Treatment
Treatment principles are divided into two main parts: surgical and non-surgical. p>
Non-surgical treatment
Physical therapy, including compression therapy and massage, is applied to the patient's limb. Drainage of accumulated lymph fluid is attempted through compression and massage therapy. Between these treatment periods, the patient continues the compression with special clothing in his normal life. In cases where the benefit of this treatment decreases and the edema treatment cannot be completely resolved with these treatments, surgical treatment methods are started to be applied.
Surgical treatment
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 also be applied.
Tissue Removal. Surgeries
Liposuction
Lymph and vein joining surgeries (Lymphotic-venous shunt)
Vascular lymph node transplantation
Tissue removal surgeries
Lymphedema These are the first surgical procedures used in the treatment of Although it appeared aesthetically difficult to accept, it was an alternative surgery method at first. However, as other methods began to be used in plastic surgery, they became less preferred and began to be applied only to selected patients. In my clinic, I use this surgical technique in stages, which is different from the classically defined method, in selected patients who have long-term lymphedema and an excessive amount of excess skin and fat tissue. Following this, I perform vascular lymph node transplantation on my 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 on unsuitable patients, it will remove the fat tissue from the patient, while on the other hand, it may damage the lymph channels that may have remained intact.
For this reason, I use liposuction surgery on my patients who do not accept vascular lymph node or tissue removal surgery.
p>
Lymph and vein joining surgeries
In these surgeries, before the blocked lymph vessels area, a procedure is performed to overcome this blocked area by combining the intact lymph vessel channel to a vein with a supermicrosurgical technique. is the method. This surgical method has revolutionized the microsurgical treatment of lymphedema by defining the supermicrosurgical technique in the scientific world.
Schematic Lymphatic Vessel and Vein Anastomosis
Schematic view of the anastomosis (Yellow lymph vessel and if blue is vein)
I use this method alone on very rare patients. I think that this method, combined with vascularized lymph node transplantation, gives very successful results in suitable patients.
Vascular lymph node transplantation
In recent years, it has been introduced to the scientific world. After I started to see the successful results of this method in national congresses, I started to apply this method as the first method in many of my patients in lymphedema surgery. In this method, lymph nodes from another part of the body are vascularized to the limb with lymphedema and transported to the vessels of that limb using microsurgical techniques.
In patients where this technique is suitable for application, an average of 30% of the limb loss is lost in the first month without any physical therapy or compression after surgery. I see it decreasing in volume. Although it varies from patient to patient in the long term, this volume reduction continues to increase.
Read: 0
