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Advice post surgery

Advice from a professional please 4 months ago I had surgery to attempt to restore the lymphatics in my left arm that had lymphodema following breast cancer.

Yesterday I stupidly managed to sustain a serious wound with a carving knife to my index finger on the same arm that required 5 stitches,

I phoned my Lymphodema clinic for advice re wearing my compression garment the reply wasn’t helpful ..I was concerned about a build up of fluid if I wear my garment,in my hand.

Should be ok didn’t reassure me,any advice please as two weeks before stitches are removed and I usually wear my garments in the day !

Thanks

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I have sent you a PM XXX

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hi davina

you dont say what advice you did receive from your clinic. im assuming your garment doesnt cover your hand/include fingers? if it doesnt you might feel less worried if you have a lightweight glove aswell. haddenham healthcare have a microfine glove which you should be able to tolerate over stitches and is available on prescription. it might be worth also contacting the clinic that did your surgery.

MLD would also help.

i am a lymphoedema nurse specialist (20 years nhs and now in private practice) so would hope my nhs colleagues would see you for reassurance and arm measurements. maybe ask again?

hope thats helpful x

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Hi, i am not a professional but i have had surgery (LVA after breast cancer) and some wounds on that arm. Some have been small cuts but one was a large flap of about 2 cm from tripping and falling on an overturned wheel Barroll in a stable. I have treated all the wounds with antibiotic ointment and bandage changed at least daily until they were healed. None have caused swelling. I think if you care for the wound carefully and continue with your normal LE management you should be OK. IF you see any increase in swelling you can see your therapist and or LE Doctor.

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Dear Davina - I am a plastic surgeon with an interest in lymphoedema. I'm sorry to hear about your injury.

I suggest making sure the wound is clean and sutured (hopefully done already). A wound can tolerate compression on it without a major problem so even if it is under a glove it should be ok. Pulling on your garment might cause shearing so you don't want to pull the wound apart if it is really tight to get on. If you don't want to wear your garment then elevation would be advisable. Movement of the fingers also should help to pump fluid out of the hand and keep your flexibility and range of movement. (I am assuming you had no tendon, nerve injury) Probably the most important thing is to monitor for infection and treat early if you suspect infection. If there is evidence of infection - increasing redness, pain, swelling, fevers - they you see you GP ASAP for appropriate antibiotics using the British Lymphology Guidelines for reference. (https://www.lymphoedema.org/images/pdf/CellulitisConsensus.pdf)

You mentioned you had a surgical procedure for lymphoedema recon. I suggest you contact your surgeon for advice. Take a photo of your wound and send it to them for advice as they will have a greater knowledge of your clinical stage, garments etc. I'm sure they would want to help and support you at this stage. (If you had your surgery at the Oxford Lymphoedema Practice, please ring Kate and we'll get back to you by phone straight away). BTW - liposuction and LVA have been shown to significantly reduce the risk of cellulitis in the limb so your surgery may have a protective effect.

I hope this is of some help.

AR

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Many thanks the wound was dressed again yesterday and is very clean I will return again Friday to have the steristrips removed and then in one week the stitches.

My Lymphodema clinic NHS were unhelpful when I phoned them I did wear my support yesterday for a few hours but felt my finger throbbing so took it off later.

Hopefully the LVA in October will have helped stem any further cellulitis.

Thanks Linda

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Sounds like all is going well. Sensible to be guided by how your arm feels. If there is a little extra fluid and swelling you should be able to get it back under control with your garment once the finger is healed. Good luck. Did you get a good result from the LVA?

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At this stage the outcome is a little uncertain the surgeons managed to connect 14 anastomoses in four incisions one other failed to locate a vein!

I’m optimistic in time that I will have a positive outcome this is The NHS so having had one check up post op at 3 months now have to wait until October for my next thanks Linda

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Sounds like they gave it a good effort. Time to be patient. Good luck and hope the finger sorts itself out soon.

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Many thanks for your advice and support

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