Leg surgery with lymphodaema

[Roloshebamartha]

Has anyone with primary lymphodaema had orthopaedic surgery, specifically foot or ankle surgery? If so, what pre surgery precautions or treatment did you take and how was the post op management of your lymphodaema?

[Chris21]

Hi Roloshebamartha, welcome to the group, sorry I cant help with your question as I’ve never had surgery on feet or ankles. I’m sure the consultant will be able to advise you on what to do with recovery. Good luck with you op.

[Roloshebamartha in reply to Chris21]

Thank you for your kind welcome and good wishes. Very much appreciated.

[Lynora]

Are you in the UK? Ask your orthopaedic surgeon to liaise with your lymphoedema clinic - they might need to consider post-surgical compression.

I’ve seen plenty of successful outcomes from knee/hip replacements on lymphoedema clients. Only had experience of one ankle surgery, which was as the result of a skiing accident. It did take a while to resolve, and wasn’t as perfect as she’d hoped, but it didn’t stop her skiing again!

[Roloshebamartha in reply to Lynora]

Thank you for your very encouraging message and story! Thank you I will ask my therapist (she is unfortunately unwell at the moment) if they can work with the post op management which the consultant and physio have said can be very tricky and will be long, with possible long term effects on the leg. But they are so stretched. And though it’s good to know the worse case scenario, it’s helpful thank you to hear of better ones! I have time to research more as I am going to try a leg brace for a while, not pleasant in the heat with compression garments, orthotics and supportive footwear! A small price to pay though for some relief from pain and being able to keep moving.

[AnneBury]

I had both bunions operated on about 15 years ago. I have primary lymphoedema in both feet and legs (below knee). My lymphoedema clinic liaised with my surgeon. I had antibiotics for a week before the operation and 2 weeks after, to avoid cellulitis. I might not have remembered the exact period of the antibiotics but it was before and after the operation.

[Roloshebamartha in reply to AnneBury]

Thank you very much, that’s really helpful to know about continuing antibiotics afterwards. Did your feet/legs return to how they were before the op? Did you have compression bandaging for a while?

I am so pleased you were able to have your bunions done successfully, they can be so painful. Keeping moving is key for general health as well as the lymph problem isn’t it.

[AnneBury in reply to Roloshebamartha]

Yes, they returned to "my normal". I didn't wear my compression for a while but given I had both feet operated on at the same time I spent a lot of time sitting with my feet up. I put wraps on if I felt the need but my (ex bunion) joints were sore for a while so I couldn't put pressure on them.All worth it. Good luck!

[Roloshebamartha in reply to AnneBury]

Thank you very much! That is so encouraging to hear!

[Microsurgeon]

Lots of patients with lymphoedema need surgery on limbs affected by lymphoedema. There is an increased risk of several problems following the surgery but also depends on the stage of lymphoedema. A soft minimally swollen hand is totally different to a hard woody leg with lymphorrhea and as such each operation / patient / limb needs to be carefully considered to weigh up the risks / benefits of surgery. However several points are similar to all. 1 - You are at an increased risk of surgical site infection and you and your surgeon should read the BLS Cellulitis Consensus guidelines (search on google) for advice on antibiotics for elective surgery (you need a longer course than a 'normal' patient). 2 - You are at increased risk of wound healing problems because of 1 and also oedema impairs wound healing. 3 - Reducing your swelling before and after the operation will reduce risk 1 and 2. So elevation of the lower limb for a few days before and a longer period after the operation is important. Optimising compression before is important. Remember pulling a garment over a wound / scar can cause shearing and pulling of the scar leading to slower healing. You many need to avoid a normal stocking and opt for wraps style compression. This can give compression but avoid shearing forces at the surgical scar. 4 - Most surgeons don't often deal with patients with lymphoedema so make sure your surgeon is aware and does some reading up on the subject and is aware of the implications / risks etc. Good luck with your surgery and I hope it achieves what you need.

[Roloshebamartha in reply to Microsurgeon]

Thank you so much for this. The first consultant I saw said he would not touch my foot with a barge pole! The second I have seen doesn’t see it as a problem… so thank you this is very helpful indeed.

[Microsurgeon in reply to Roloshebamartha]

One extreme to the other!! Probably the middle ground of cautious and pragmatic approach with eyes wide open to risk / benefit. Good luck. 👍

[Roloshebamartha in reply to Microsurgeon]

Thank you, I can’t tell you how encouraging your information has been. Feeling more positive!