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Lymphedema: What Are Your Surgical Options?

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Just below your skin, you have a vast network of lymph vessels that help rid the body of toxins, waste and other unwanted materials. These vessels, as part of the lymphatic system, filter fluid through the lymph nodes and then take the cleaned fluid — which now contains infection-fighting white blood cells — throughout your body.

Lymphedema is an abnormal buildup of this fluid in any part of the body, but usually in your arms and legs. The main symptom of lymphedema is swelling of your arms or legs.

Oluseyi Aliu, M.D., from the Johns Hopkins Plastic and Reconstructive Surgery Department, explains the stages associated with lymphedema symptoms and treatment options for each stage.

What Are the Stages of Lymphedema?

To get started, Aliu says that you need to know what stage of lymphedema you have based on your symptoms. Your doctor will help assess which stage you’re in and tailor medical or surgical options to your needs.

Stage 1:

  • Abnormal flow in the lymphatic system.
  • You have no signs or symptoms.

Stage 2:

  • Accumulation of fluid and swelling.
  • Swelling goes away when you elevate the affected limb or body area.
  • Pressing on the area may leave a dent.

Stage 3:

  • Permanent swelling that does not go away when you elevate the affected area.
  • Pressing on the area no longer leaves a dent.
  • Scarring and thickening of the skin can be seen.

Stage 4:

  • Elephantiasis (large deformed limb) is evident.
  • Skin thickens 
  • Wart-like growths and extensive scarring on your skin.

Medical Options: What You Can Do at Home

There are several medical options to help treat lymphedema, especially during stage 1 and stage 2. Aliu suggests compression, elevation, infection prevention, physical therapy and massage to help alleviate swelling and other symptoms. Make a plan with your doctor that uses some or all of these treatments.

Surgical Options: What’s Available?

If your lymphedema progresses despite using medical treatments, you may be a candidate for surgery. There are several options that your doctor will discuss with you:

  • Liposuction: Once lymphatic fluid spills into your surrounding tissues, it can cause inflammation and stimulate fat stem cells to grow. Your surgeon removes this extra fat caused by lymphedema. Liposuction is typically an outpatient procedure with a very short recovery time.
     
  • Lymphaticovenous anastomosis (also referred to as lymphovenous bypass): Your surgeon uses microsurgical techniques and equipment to reroute your lymphatic system, bypassing damaged nodes and connecting lymphatic channels directly into your veins. The lymphovenous bypass is an outpatient surgery. You can return to regular activity within a few days.
     
  • Vascularized lymph node transfer surgery (lymphovenous transplant): Your surgeon transplants a group of lymph nodes from a healthy part of your body to the affected area, effectively rewiring the lymphatic system. This is an inpatient procedure with a recovery time of a few days before resuming regular activity.
     
  • Charles procedure (skin grafts): Affected tissue is removed and your surgeon uses part of it as skin grafts to repair the area. Skin grafts require more extensive care of the surgical site after your procedure, and it can take up to one month to return to normal activity.

Dr. Aliu stresses that while there is no full recovery, these treatment options significantly lower the swelling and discomfort caused by lymphedema. Talk to your doctor about the best treatment options for you. Find out more about treatment options at Johns Hopkins.

Lymphedema Surgery | Q&A

Lymphedema is a condition most commonly caused by removal of or damage to lymph nodes during treatment for cancer. Other causes of lymphedema are congenital abnormalities and trauma. Watch as Johns Hopkins plastic and reconstructive surgeon Oluysei Aliu, M.D. discusses new surgical options for the treatment of lymphedema.

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