Lymphoedema

These are the causes of lymphoedema

Lymphoedema has various causes. These include:

• Injuries to the lymph vessels
• Operations in the area of the lymph vessels (e.g. after cancer)
• Radiotherapy for tumours
• Chemotherapy
• Chronic venous function weakness
• Congenital disorders of the lymph system

Symptoms of lymphoedema

Those affected by lymphoedema suffer from:

• Swelling of the affected region
• Feeling of heaviness
• Tension or pressure pain
• Itchiness
• Recurring infections

If the lymphoedema is not treated, it can lead to serious health problems such as skin infections or deformation of the affected limb.

Types of lymphoedema

Lymphoedema can be primary or secondary. Primary lymphoedema is congenital, rare and usually associated with genetic diseases. Secondary lymphoedema is by far the more common form in Europe, which can be caused by an injury, an illness or an operation as an unwanted side effect or complication.

Primary lymphoedema
In the case of primary lymphoedema, there are malformations in the development of parts of or the whole of the lymph system. In most cases one extremity is affected, rarely both. In many cases, primary lymphoedema is associated with other genetic diseases. 

Secondary lymphoedema
Secondary lymphoedema usually occurs

• as an unwanted side effect or complication of a disease, e.g. breast cancer (20-40 %), prostate cancer (10-20 %)
• after operative interventions, e.g. after radical prostatectomy and/or lymph node removals (lymphadenectomy)
• after radiotherapy
• due to certain chemotherapies
• due to chronic venous insufficiency
• due to skin diseases such as erysipelas, lymphangitis or cellulitis
• as a side effect after a parasitic disease
• due to obesity

How lymphoedema develops

Lymphoedema develops in four stages:

Stage I: The lymph system is compromised but still does not cause any symptoms.

Stage II: The lymphoedema is clearly in evidence but can be partially reduced by raising the affected part of the body.

Stage III: In this stage, the lymphoedema has already become chronic and can no longer be reduced by raising the affected part of the body.

Stage IV: Elephantiasis: The affected part of the body is misshapen, stretched and is painful to the touch. It is often exacerbated by badly healing wounds and chronic infections.

The treatment of lymphoedema

In most cases, lymphoedema is very unpleasant and compromises the quality of everyday life to varying degrees. Depending on the severity of the lymphoedema and the general state of health of the patient, the following treatments are available as part of the initial treatment and as accompanying measures:

1. Complex physical decongestive therapy (CDT)
Complex physical decongestive therapy is usually already carried out regularly by the affected person to reduce the discomfort of pressure at least temporarily. This type of treatment comprises manual lymph drainage, bandaging, compression dressing, special skin care and hygiene measures, as well as kinesitherapy.

2. Nutritional advice
Lymphoedema patients need, in addition to conservative and surgical measures, a special and individually composed nutrition that can be ensured by trained and experienced nutritionists.

Operative treatment can help to halt the progression of lymphoedema and to ease the symptoms. In some cases, an operation can lead to the lymphoedema regressing completely and lymph flow normalising. On the basis of supermicrosurgery, we are technically able to operatively restore the function of the lymphatic system.

OUR TECHNICAL OPERATION BASIS OF SUPERMICROSURGERY

Supermicrosurgery is a further development of microsurgery that allows the preparation and suture of vessel diameters of under 1 mm. Not only are specially made, superfine instruments required for this but also extremely high-resolution microscopes (up to 70-fold magnification). The necessary suture materials are smaller than 0.1 mm.

Always depending on the individual situation and the clinical severity of the lymphoedema, we offer a range of operation methods:

a)  Lymphovenous Anastomosis / LVA
In order to bypass a local drainage problem, it is possible with the help of supermicrosurgical operation techniques to reconstruct the drainage of the lymph through the suture of several lymph vessels on superficial veins. Patients in the lymphoedema stages I and II are suitable for this operation method.

b) Lymph node transfer 
Healthy lymph nodes can be transplanted into a congested lymph drainage area and be connected by means of supermicrosurgical operation methods to an arterial supply and a venous drainage. The transplanted lymph node thus takes over the drainage of lymph fluid. In some cases, such as in stage III, lymphovenous anastomosis can be combined with a lymph node transfer. 

c) Lymphoceles
Lymphoceles usually occur as a consequence of operative interventions, after which lymph fluid flows freely into the tissue and pools. Lymphoceles usually regress by themselves after some weeks. In cases of persistent lymphoceles, lymph flow can be restored by means of LVA (Lymphovenous Anastomosis) using supermicrosurgical operation techniques.