Munnoch: Liposuction only if patient is fully compliant with garments 24/7 #lymphedema #BLS2014
Most of my patients want to get rid of their compression #lymphedema #BLS2014
Ramsey: 60% patients undergoing lymph node transfer patients have decreased lymphatic function in donor limb #lymphedema #BLS2014
I have discussed microsurgery for lymphoedema extensively on this forum over the last few weeks, so I think it is only fitting that my final post discussing developments from the ESL and BLS meetings covers other surgical options. Essentially, they fall into two categories: Liposuction and lymph node transfer.
Alex Munnoch from Dundee discussed his experience with Liposuction. The rationale here is that the presence of fluid drives the laying down of excess fat in the limb in the later stages of lymphoedema. The procedure therefore removes this excess fat, reducing the limb to normal or near-normal size.
Please note that this is very different to cosmetic liposuction, and certainly very different to “micro-liposuction” that some cosmetic surgeons might offer for lymphoedema. This procedure was pioneered by Hakan Brorson in Sweden, and any surgeon offering this operation should have been to Sweden to train with him.
This is major surgery done under General Anaesthetic, with a weeklong stay in hospital afterwards. Complications are relatively infrequent, but can be serious. Results are good, with arms or leg being reduced back to normal size. But (there had to be a but…….) the major drawback of this surgery is highlighted in my tweet - Liposuction only works in the long-term if the patient is fully compliant with garments 24/7. As soon as the patient stops wearing garments, the fluid re-accumulates, and the lymphoedema recurs. This is because the underlying problem that caused the lymphoedema hasn’t been addressed as it is with LVA. Most of my patients want to be rid of their garments more than anything, so most would not be suitable for liposuction.
Anne Dancey from Birmingham spoke about lymph node transfer for lymphoedema. Here, under General Anaesthetic, a lymph node is taken from an area unaffected by lymphoedema and placed into the area that is affected. It involves a 5-7 day stay in hospital after the procedure. There is then a process known as lymphangiogenesis (possibly), which improves lymphatic function. No-one really knows how this operation works. No-one has demonstrated lymphangiogenesis, or improved lymphatic drainage from the affected limb. There are some studies showing some effectiveness, but they are not high quality, and more work needs to be done.
There is also one further problem, highlighted by Kelvin Ramsey from London highlighted in my other tweet - 60% patients undergoing lymph node transfer patients have decreased lymphatic function in donor limb. This means that people who are already suffering with lymphoedema in one limb run the risk of developing lymphoedema in another limb that is currently normal. Again, most of my patients do not want to take this risk.
Given these considerations, it can be seen why LVA, a minimally invasive procedure performed under local anesthetic as a day case is the procedure I have adopted. The physiology of the procedure also makes sense to me (see my post on “How does microsurgery work?’).
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