What is Lymphoedema?
Lymphoedema (US spelling lymphedema) is an extremely debilitating condition in which lymph fluid accumulates under the skin, leading to swelling, pain, skin/soft tissue changes and impaired limb function. Patients also have increased risk of infection in the affected limb, sometimes requiring antibiotics and admission to hospital.
Throughout the body is a network of vessels that transport excess fluid (known as lymphatic fluid or lymph) back to the heart. The lymphatic system is very similar to the venous system which serves to transport blood back to the heart.
In patients with lymphoedema the lymphatic system is not working properly, resulting in a build-up of excess fluid in the affected limb. There are many reasons why the lymphatic system may not be working, for example;
- The lymphatic channels (or the lymph nodes they drain into) become damaged because of surgery, injury or infection
- The lymphatic channels become blocked
- The lymphatic channels do not contract correctly or the internal valves become incompetent
- The lymphatic channels are reduced in number or absent from birth
In the United Kingdom, surgery for cancer or radiotherapy is the most common cause of lymphoedema. Women who have undergone breast cancer treatment with lymph node removal are at risk of developing arm lymphoedema. Similarly, women who have undergone surgery for uterus cancer are at risk for developing leg lymphoedema.
Not all women who have had breast cancer surgery with lymph node removal go on to develop lymphoedema.
How is lymphoedema classified?
Patients with lymphoedema are referred to as having either primary or secondary lymphoedema.
Those with primary lymphoedema are born with an absence of lymphatic channels or have abnormalities in the lymphatic channels, whereas those with secondary lymphoedema develop lymphoedema as a consequence of damage to previously normal lymphatic system e.g. following surgery, radiotherapy or infection.
What are the signs & symptoms of lymphoedema?
The signs and symptoms of lymphoedema include;
- Swelling of the arm or leg (or a part of) – the swelling can range from mild, hardly noticeable change to extreme swelling.
- Thickening and hardening of the skin
- A feeling of heaviness or tightness in the arm or leg
- Aching or discomfort in the arm or leg
- Recurring infections in the affected limb
- Restricted range of motion in the limb
What are the complications of lymphoedema?
Lymphoedema in the arm or leg can cause serious complications, such as;
Cellulitis, a bacterial infection of the skin. It is very important patients look after the skin and seek treatment as soon as cellulitis appears.
Lymphangiosarcoma, a very rare type of soft-tissue cancer.
How is lymphoedema diagnosed?
The diagnosis of lymphoedema is often made on the history and examination alone. Patients who develop limb swelling after lymph node surgery can be readily diagnosed in this manner.
History and examination can also be very helpful in excluding other conditions that cause limb swelling.
For some patients, specialised imaging may be necessary to confirm the diagnosis or exclude other conditions that cause limb swelling.
- Ultrasound scan
- Lymphoscintigram – this test involves injection of a radioactive dye into the affected limb. It provides valuable information on the patency of lymphatic vessels in that limb.
- CT / MRI scan
What are the treatments for lymphoedema?
The main objective of lymphoedema treatment is to reduce volume of the affected limb. Patients should also benefit from an improvement in symptoms as well as a reduction or elimination of recurrent infections.
Lymphoedema treatments are broadly divided into non-surgical or surgical, with the majority of patients managed with non-surgical therapies. Surgery becomes an option for those who do not respond to non-surgical treatments or have reached plateau despite strict compliance with manual lymphatic drainage (MLD) and Compression.
Compression garments – Compression garments are made from low-stretch fabric and apply external pressure to the affected limb, thereby preventing accumulation of lymphatic fluid.
The use of high quality and appropriate Compression garments is essential for the long-term management of lymphoedema and to have the maximum effect must be worn daily and should be replaced every six months. It is ideal to have two sets of garments.
Manual lymphatic drainage (MLD) – a highly specialist massage technique that promotes lymphatic flow. Manual lymphatic drainage serves to move lymphatic fluid to an area where it can flow more freely.
MLD can be applied to areas that cannot be treated with Compression garments and compressive devices. It is contraindicated for anyone with untreated malignant disease, right-sided heart failure, thrombosis or acute infection.
Kinvara Private Hospital offers several types of surgery for lymphoedema, these include;
Can be used to remove the excess fibro-fatty tissue that develops in long-standing cases of lymphoedema. This surgical option is particularly effective for reducing the size of a lymphoedematous arm or leg, and the results are predictable and long-lasting.
Liposuction for lymphoedema is very different to cosmetic liposuction and must be performed by an experienced surgeon. Furthermore, it is essential all patients continue to wear their Compression garment after surgery to maintain the reduction in limb volume.
Liposuction for lymphoedema is performed under general anaesthetic with an overnight stay in hospital.
For some patients it may be necessary to surgically remove the enlarged, fibrotic tissue to improve limb range-of-motion, treat recurrent skin infections or improve limb shape.
Underarm (axilla) scar release
Compression of the axillary vein by scar tissue following armpit lymph node removal can contribute to the development of arm lymphoedema. This is particularly relevant to women who have undergone armpit lymph node removal as part of their breast cancer treatment.
By releasing the scar tissue, venous drainage from the arm improves and this in turn leads to an improvement of the lymphoedema.
LIVE SURGERY | Upper Limb Lymphoedema (Lymphedema) Liposuction | Patient Interview
LIVE SURGERY – Lymphoedema debulking surgery | Mr Vasu Karri | The Karri Clinic | Kinvara Private Hospital
Consultants who do this treatment
Mr Vasu Karri is a Consultant Plastic Surgeon in full time private practice in East Yorkshire. He is on the General Medical Council (GMC) specialist register for plastic surgery, certified by the Royal College of Surgeons of England in plastic surgery and a member of British Association of Plastic Reconstructive & Aesthetic Surgeons (BAPRAS).