Useful information for patients

Lymphedema is the swelling of a limb due to the absence or dysfunction of the lymph nodes or lymphatic vessels, and it can be primary (congenital) or secondary. More often lymphedema can occur secondarily, several months or even years after an operation with axillary or inguinal lymph node resection and sometimes additional radiotherapy.

Primary or congenital lymphedema is the situation when some children are born with mild or severe absence of lymph nodes or lymph vessels. Lymphedema can be presented immediate after birth ore some years later.
Primary lymphedema is treatable, but requires a different surgical approach. The lymph nodes are transplanted near the most impaired side of the lymphedema and help the absorption of the excess fluid through the blood vessels.There are some situations in which we prefer performing lymphaticovenous anastomosis (LVA) redirecting the lymph to the blood circulation. Any decision for the different surgical technique is obtained after meticulous investigations with MRI and Lymphoscintigraphy.

The onset of lymphedema can be insidious and the progression involves skin thickening with appearance of vesicles, colour changes and more frequent infections. Recurrent infections lead to gradual fibrosis (“scar like” appearance) and eventually the progressive destruction of the lymphatic system. Lack of local hygiene leads to these secondary infections and eventually advanced elephantiasis.

Axillary lymph node clearance and radiotherapy are used for breast cancer treatment. A number of patients as high as 40% may develop permanent upper limb lymphedema

Lymph node transfer (LNT) can also be seen as Vascularized Lymph Node Transfer (VLNT) or Autologous Lymph Node Transfer (ALNT) is the transplantation of 2-3 lymph nodes from a healthy part of the body to the limb which suffers from lymphedema. Immediate, there is a connection between the lymphatic vessels of the affected limb and the healthy part of the body and the lymphedema start to be subsided.

There is a growth of new lymphatic vessels (lymphangiogenesis) and restoration of continuity of the lymphatic system.

The operation of Lymph Node Transfer lasts for about 3 hours and the hospital stay is 2-3 nights. There is a comfortable post op period and the patients can walk few hours after the operation. In 2-3 weeks patients can return to everyday activities. Manual lymphatic drainage by our lymphedema therapists starts 2 weeks before the surgery and continues 2 days afterwards. Both physiotherapies before and after the operation are essential to achieve optimum results.

The majority of lymphedema patients benefit from LNT procedure. Few months after the operation patients report a reduction in the size of the extremity, a reduced feeling of “heaviness”, a reduction of infections (cellulitis), and an increased range of motion.

This is the greatest concern for all of our patients. To avoid such a kind of complication, we harvest superficial lymph nodes from the groin or the armpit and not those nodes who drain the limbs. Additionally we were the first to describe the “Selective Lymph Node” technique, in which we choose precisely the best and appropriate lymph node; guided from an advanced lymphatic imaging (SPECT-CT) and therefore minimize to “zero” the risk of donor site lymphedema.

Patients which are interested in reconstructing their breast after mastectomy and also suffer from lymphedema can undergo in one surgery at the same time. Skin and fat from the abdomen including 2-3 lymph nodes can be harvested and reconstruct the breast and cure the lymphedema at the same procedure. If abdominal tissue is not indicated, skin and tissue from the back can be an alternative option. These combined procedures allow simultaneous treatment of both problems with superior aesthetic results.

Lymphedema in lower limb often can occur after extended radical hysterectomy for cancer or melanoma excision of the leg and lymph node clearance, or after radical excision of lower pelvic malignancy with the lymph nodes.
Results after a LNT operation show improvement of the lymphedema in the majority of patients. Even in very long standing lymphedema cases with extensive fibrosis, there is satisfactory reduction at the volume of the leg and decreased number of infection episodes.

Both primary and secondary lymphedema patients can be treated with LNT.
Most patients who experience lymphedema following cancer treatment are potential candidates for lymph node transfer. Both mild and severe or advanced cases have been successfully cured with lymph node transfer. Performing LNT in an early stage of lymphedema will lead to permanent cure of the disease and the limb can return to normal. However, in advanced lymphedema cases or in elephantiasis, the fluid is eventually replaced by fatty tissue which an additional liposuction can be performed.