The foundation of lymphoedema treatment is Complex Decongestive Therapy (CDT), a combination of conservative (non-surgical) therapies, such as Manual Lymphatic Drainage (MLD) or compression therapy.
Surgical therapies may be an option when conservative treatment is insufficient at treating your lymphoedema. Usually, CDT is continued for at least 6 months.
Surgery may also be necessary in the following cases:
- Severe swelling and deformities
- Excessive soft tissue after successful decongestive therapy
- No response to compression therapy
- Recurrent cases of bacterial cellulitis
- Lymphoedema of the eyelid or genitals
- Long-term complications, such as lymphangiosarcoma
- Connections between the lymphatic system and the skin (lymphocutaneous fistula)
What types of lymphoedema surgery are there?
Depending on the reason for surgical therapy, there are different types of lymphoedema surgery:
- Microsurgery to reconstruct the lymphatic system
- Surgical reduction to remove excessive tissue (debulking)
- Liposuction to remove the fatty tissue and to improve the limb shape and size
There are different types of microsurgery but all aim to reconstruct the lymphatic system. Before microsurgery, the function of your lymphatic system has to be visualised. A small amount of fluorescent dye is injected into your lymph vessels. The lymph flow transports the dye and gives a picture of your lymphatic system and its function. Here is an overview of the different types of microsurgeries that reconstruct the lymphatic system:
Lymph vessel transplantation: Well-working lymph vessels from your body are transplanted to the area with non-working or missing lymph vessels.
Lymph node transplantation: Well-working lymph nodes from your body are transplanted to the area with non-working or missing lymph nodes, together with their surrounding tissue.
Interposition of veins: A vein from your body is used to build a bridge between your lymph collectors to improve Lymphatic Drainage. This technique can be used to restore the lymph passage when the lymphatic flow is blocked.
Lymphatic-venous and lymphonodulo-venous anastomosis: Anastomosis is the medical term for a connection between two structures. Surgeons create a local connection between the lymph vessels and a vein (lymphatic-venous anastomosis) or a lymph node and a vein (lymphonodulo-venous anastomosis). The technique aims to improve the drainage of the lymphatic flow.
Surgical reduction may be necessary following successful decongestive therapy to remove excessive tissue and improve the limb's shape. It may also be an option for patients with lymphoedema of the eyelid or external genitals, or to reduce the symptoms of severe lymphoedema.
Liposuction for lymphoedema patients aims to remove the fatty tissue and to improve the limb shape and size. It does not treat your lymphoedema itself and does not improve Lymphatic Drainage. Liposuction usually requires general anesthesia and an overnight hospital stay. Compression therapy is an essential part before and after liposuction to ensure the therapy's long-term success.
Secondary lymphoedema can develop if you are overweight and can also impair existing lymphoedema. Bariatric surgery may be an option for certain patients with difficulties losing weight.
What are the risks of lymphoedema surgery?
The different surgical options all have their risks. Some general risks can occur after all types of lymphoedema surgeries, such as infections, bleeding, or damage to the nerves and vessels during surgery. Lymphoedema surgeries are not suitable for every lymphoedema patient. If you want to know more about surgical treatments for lymphoedema, a discussion with your healthcare professional (HCP) is recommended.
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