LymphnVascular

Frequently asked questions (FAQs)

Lymphedema is swelling of skin and underlying structures below the skin, due to accumulation of a fluid called LYMPH. LYMPH is a special type of fluid which arises due to metabolism in the body.

Just like blood vessels in our body, there is a network of similar pipe like structures called lymph vessels which carry additional fluid from the different parts of the body, purify it like a filter and then transport that fluid to the blood vessels so that they are back in the system. The purifying stations are called LYMPH NODES, which we commonly know as GLANDS. The glands which we feel in the neck, groin and axilla.

LymphnVascular  LymphnVascular
The lymphatic net work starts with tiny lymph collecting vessels starting in our feet, legs, hand, forearms, body, breast, head, neck and in fact all parts of the body. Once the lymph fluid is collected, it is transported towards the lymph nodes (glands) using a special valve like mechanism. In the lymph node, the lymph is filtered and a relatively cleaner lymph is then further transported till they ultimately drain into a major vein and thus come in the circulation. As explained before, this network is a system in addition to the blood vessels.

Whenever, there is an obstruction to this system, there is accumulation of fluid due in the portion before the obstruction. This accumulated fluid is lymph and the swelling is called lymphedema. For example, if there is obstruction in the axilla, the upper limb ( hand, forearm arm) will swell. If there is an obstruction in the groin, then the leg, calf, thigh will have the swelling. Depending on the cause of the obstruction, lymphedema is of different types.
 

The various types of lymphedema are

A) Congenital (By birth)
B) Acquired (Obstruction due to some disease)

Congenital Lymphedema - In this condition, the lymph channels are not developed. Depending on how less the lymph channels are, the swelling can develop immediately after birth, or can happen in adolescence or sometimes it can manifest even after 35 years of age ( Lymphedema tarda).

Acquired Lymphedema - These may be due to

i) Disease like Filariasis ( HAATHI PAO) where the filarial worms get lodged in the lymph vessels and destroy the valve. Because of this, the lymph is not able to travel to the glands and gets accumulated in the lower limb. Lower limb is most common because the mosquito carrying the filarial germs bites the legs. This is very common in South India and Eastern India.

ii) Cancer Surgeries in which the glands are removed, such as breast cancer. We all know that many cancers spread through the lymph nodes. For such cancers, the optimal surgery involves removal of the cancer as well as the lymph nodes. When the lymph nodes get removed, the lymphatic fluid flow is obstructed and thus the swelling starts. In Breast cancer, the glands in the axilla are removed, so the upper limb becomes swollen. In some cancers like cancer of genitals and leg, the groin lymph nodes are removed, hence the lower limb swelling occurs.

iii) Radiation-Radiotherapy to the axilla or groin may give rise to the swellings of upper or lower limb.

iv) Trauma - Trauma or injury to lymphatic system may cause swelling.

There are many causes of limb swelling. The doctors can examine and tell you in most of the cases whether it is lymphedema or not especially if there has been a surgery or radiation or if the typical feature of elephantiasis is seen. But many cases require investigations before one can be sure whether it is lymphedema or not. Usually, but not always, lymphedema does not happen on both the limbs at the same time.
 
Plastic surgeons are best suited for lymphedema treatment. Till sometimes back, there was no good treatment for lymphedema hence it was not in focus. But over last few years, some good surgeries and therapies have come up. So among the plastic surgeons also, some lymphedema expert surgeons are there who are best suited. Our center, La transformatione' offers one of the best comprehensive lymphedema management with both Nonsurgical and Surgical options. Dr. Anshuman Manaswi, M.Ch., has a lot of experience in treating lymphedema cases.
 
  • Clinical examination.
  • Lymphoscintography.
  • Lymphangiogram
  • MR lymphangiography.
  • Sonography.
  • Venous colour doppler to rule out venous problems.
  • Lymphangiography and MRI are most useful.
 

The treatment of Lymphedema can be divided into two parts
A) Non Surgical
B) Surgical

NON SURGICAL

i) These consists of a special type of massage technique which open some dormant lymphatic side channels and thus decrease the swelling. This massage technique is called MANUAL LYMPHATIC DRAINAGE ((MLD).

ii) Compression bandage : This is usually 3 or 4 layered bandage which is applied in a particular manner to keep the gradiant of flow of lymph.

iii) Lymphatic pumps : various pumps are there in the market. But these should be used very carefully because the high pressures can not only be Ineffective but also may damage the delicate lymphatic channels

The non surgical treatment has to be learnt and practiced at home regularly. If these are done regularly, it is helpful in a lot of patients. But these have to be continued life time.

SURGICAL TREATMENT
The Surgical treatment helps in many patients and for long terms. The various surgeries are

i) LYMPHATICS – SMALL VEIN SHUNTS: It is One of the most effective surgeries . It is a micro surgery where in the lymph channels before the obstruction are joined to nearby veins, thus bypassing the obstruction

ii) LYMPHNODE – VEIN SHUNTS : These are effective in filarial cases and when the obstruction is after the lymph nodes.

iii) VASCULARIZED LYMPH NODE TRANSFER : Here, some lymph nodes from other parts of the body are taken and transplanted in the affected area.It has also been found to stimulate the regeneration of the lymphatics.

iv) LIPOSUCTION : Liposuction is also effective decreasing the swelling for a long duration

v) EXCISION : Excision of extra skin or bad skin is done many times to improve the situation.

The complications of lymphedema are

i) Mechanical : heavy limbs or genitals

ii) Progressive increase in the swelling if not treated

iii) Infections, which can become serious with pus forming, skin damage etc. which may lead to various surgeries and treatment of infections. All these can be very debilitating and morbid for the patients.

iv) Malignancy : sometimes in the scars, cancer can also originate.

The most important way to prevent a complication is to get appropriate treatment and lead a disciplined life. Apart from that prevention of Infection by means of good hygiene , nail care, web space care etc. are very important.
 

When the patient comes for the first time, and then at every visit , a detailed evaluation is done including history of any fresh problem. The limb ( leg or arm) is assessed for any infection or impending infection.

Various measurements are serially taken to see the progress.

In this way we are able to objectively evaluate the patient rather than subjective.

Periodically photographs are also taken for better assessment.

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