A permanent cure for lymphedema?
Also known as Vascularized Lymph Node Transfer (VLNT) or Autologous Lymph Node Transfer (ALNT) LNT is a procedure suitable for almost all lymphedema patients, offering a permanent solution changing completeley the patient’s life.
Lymph node transfer (LNT) can also be seen as Vascularized Lymph Node Transfer (VLNT) or Autologous Lymph Node Transfer (ALNT).
The idea of lymph node transplantation is to transfer 2-3 lymph nodes from a healthy part of the body to the limb which suffers from lymphedema. Then, there is a connection of the blood vessels between the vessels of the lymph nodes and the vessels of the swollen limb.
Dr Dionysiou explains to the lymphedema patients for the efficacy of the lymph node transfer.
How does it work?
After the transplantation of the lymph nodes there is a growth of new lymphatic vessels (Lymphangiogenesis) and restoration of continuity of the lymphatic system. For example, when the lymph nodes are placed in the armpit of a lymphedematous arm – in a woman who had breast cancer, they “bridge” the gap and reconstruct the continuity of the lymphatic system. Trapped lymph enters into the transplanted lymph nodes and lymphedema is gradually subsided.
Is it a difficult operation and how is the recovery time?
The operation of Lymph Node Transfer takes place in 3-5 hours and the hospital stay is 2-3 nights. Patients are encouraged to walk in a 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.
How effective is the lymph node transfer procedure?
LNT can provide a cure for lymphedema in the majority of the patients. After the operation patients often report a reduction in the size of the extremity, a reduced feeling of “heaviness”, a reduction of infections (cellulitis), an increased range of motion and removal of compression garments six months later.
Can the removal of a lymph node cause lymphedema?
The greatest concern for all patients is the risk of developing lymphedema at the limb where lymph nodes are removed. Mostly we harvest lymph nodes from the groin or the armpit. Many anatomical studies have been proved the safety of the operation when we avoid taking the nodes that drain the limb. 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.
Who is a candidate?
Most patients who experience lymphoedema following cancer treatment are potential candidates for lymph node transfer.
Both mild and severe or advanced cases of lymphoedema have been successfully cured with lymph node transfer.
Performing LNT in an early stage of lymphoedema will lead to permanent cure of the disease and the limb can return to normal. However, in advanced lymphoedema cases or in elephantiasis, the fluid is eventually replaced by fatty tissue and scar. In such cases LNT can help remove the obstructed fluid and an additional liposuction or skin excision can be performed to reduce the skin and fatty tissue excess.
Is physiotherapy needed?
Physiotherapy is essential to be performed almost daily for 2-3 weeks after the lymph node transfer and must be done by a specialized therapist team.
It is actually a lymphatic drainage and not a classic massage, with maneuvers that are “pushing” the extracellular liquid through the lymphatic vessels into the transplanted lymph nodes. Within a short period of a few weeks the lymphatic system “is self-educated” to transfer the excess fluid of the limb at the new lymphatic vessels.
Bandaging is necessary a few weeks after the operation