A new method for treatment of chronic lymphedema of arms and legs
Lymph is produced as the result of hydrostatic filtration of blood in the smaller blood vessels. Normally lymph is removed from the extracellular space via small lymph vessels and is then carried to the lymph glands. From these glands the lymph finally empties into the blood stream.
At the time of a radical mastectomy, the axillary lymph glands are removed to prevent any spread of the cancer. Many of these patients develop lymphedema of the arm due to the impaired lymph drainage, which is further exacerbated by post-operative irradiation. The accumulating lymph and the thickened subcutaneous fat leads to chronic lymphedema. After some time subcutaneous fibrosis can develop. Common symptoms of chronic lymphedema are pain, a feeling of heaviness and decreased mobility of the arm.
Conservative therapies (manual lymph therapy according to Foldi, compression garments), if used early, can remove the edema, but in long-standing cases this is not always possible. To date there has not been a surgical procedure that completely removes the edema after breast cancer treatment. At the Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden, a new and unique method of complete removal of chronic lymphedema has been developed using a special liposuction technique. The edema and the increased subcutaneous fat are removed via some 15 small incisions along the arm. This results in disappearance of pain and feeling of heaviness as well as an increased mobility of the arm.
A prerequisite to the success after the operation is a vigilant use of a custom-made compression garment. This garment has to be used at all time or lymphedema inevitably recurs.
We have operated on 123 patients to date using this technique. The mean volume of the lymphoedema was 1.7 liters. The edema reduction is complete, and no recurrence of the edema has been seen at 17 years follow-up.
Also leg lymphedema, congenital or after cancer treatment, can be successfully treated with this method. Up to now 45 patients have been treated with a mean excess volume of 4,5 liters (range, 1,2-14,3 liters) and a follow-up at most 11 years.