Lymphedema and Lipedema Surgery
Lymphedema is a blockage of the lymphatic system, stopping to function normally causing an excessive accumulation of lymph (fluid that helps fight infection and disease). This accumulation of proteins in the subcutaneous tissue is manifested as chronic swelling in one or more parts of the body, causing heaviness, decreased mobility and quality of life of the patient.
The increase in volume of the affected limb is due not only to lack of removal of lymph (fluid) but also causes medium and long-term increase in subcutaneous fat.
It is often considered that lymphedema occurs only in arms and legs, however other body regions such as the genitals can present it due to different pathologies.
The first cause of lymphedema in our environment is lymphedema secondary to breast cancer treatment. The incidence is about 20%, especially in those patients who received axillary surgery.
Lipedema is a type of lipodystrophy, an alteration of the formation and distribution of subcutaneous fat, which may occur at different stages of life, although the most common is the pubertal. Mainly affects the lower but also in the upper extremities. This disease mostly affected women and remains greatly unknown. Its origin can be inherited (congenital type) although there are different factors some of which remain unknown affecting this pathology.
Lipedema can be pure or mixed, lipedema accompanied by lymphedema. Lipedema has a treatment in all cases, it will depend on its manifestation, if it is a pure lipedema to do selective lymph lipoaspirator:,remove the fat by suction through small incisions, respecting the lymphatic system functioning. If it is a mixed lymphedema, which means having a portion of alteration of the lymphatic system and a portion of fat hypertrophy, first we must study the lymphatic system to see if we can repair the lymphatic system and in a second phase, hypertrophy fat must be treated as explained above.
All lipedemas improve, although the improvement depends on the volume of fat hypertrophy, patient quality of skin and vascular component. Another important factor is the age of the patient because as younger the patient can get the better the result because the skin responds best to the volume reduction, larger capacity of contraction. We can say with absolute honesty that all patients improve their quality of life; considerable reduction in volume, removing the feeling of heaviness and patients with good skin quality can achieve restitution contour as if they had never had a lipedema.
To be valued according to particular case
To be valued according to particular case
Surgical treatment of lymphedema can be divided into 2 groups of techniques: reconstructive microsurgical techniques and reductive techniques.
1. Reconstructive microsurgical techniques:
There are 2 techniques to emphasize that require specialized surgeons in microsurgery to practice them:
Microsurgical Lymph Node Transfer:
It involves removing healthy lymph with blood vessels in a body part where they will be dispensable, like the surface area of the groin and translate it to the armpit by using microsurgery. Nodes removed in the lymphadenectomy (cancer treatment) once transplanted in the armpit, creates a new network of lymphatic vessels (lymphogenesis) which are restored: the new network connects the lymphatic network arm with new nodes and It allows to empty the lymph through them. The accumulated lymph is reduced and a new lymphatic drainage system is created. As for the surgery performed under general anesthesia lasts between 4 and 5 hours and requires the patient to remain hospitalized 4 to 5 days.
Derivation of microsurgical lymphatic-venous:
It consists of joining the superficial lymphatics (which are just under the skin) with subdermal veins of the affected arm by supramicrosurgery techniques through small cuts in the skin (about 1 cm in length). Thus, lymphedema is discharged as lymph and derived from the lymphatic system to the superficial veins. This second option, which can be performed under local anesthesia, requires four days of hospitalization for the patient.
2. Reductive techniques (Lipedema):
Selective lymphatic liposuction:
It is to remove subcutaneous fat hypertrophy by a minimally invasive surgery. One vibro-lipoaspirator combined with proximal and distal ischemia and tumescence liquid with intraoperation study using indocyanine green to preserve the functioning lymphatic channels. In this way, we remove the fat through small incisions keeping active lymphatic system. Surgery is performed under general anesthesia, requiring 3 to 4 days in the Hospital.
In the vast majority of cases is usually sufficient with one treatment, although in certain patients with longstanding lymphedema its needed to combine techniques to get the best possible result.
Depending on the micro surgery technique, the procedure can require from one up to five days of hospitalisation.
As it happens with all treatments, prior medical consultation is imperative to detect any possible problem that may advise against this procedure. The sooner the lymphedema is treated, the better the results are. It is advisable to treat lymphedema during the first year, when there is no fibrosis yet
As important as the treatment are also the diagnosis and preoperative evaluation. Until recently, the only way to locate the lymphatic channels, was injected into the patient\\'s body pigments that offered a very low probability of finding them because of their character and microscopic dimensions. Now, thanks to an innovative scanner diagnostic, the PDE (Photodinamic Eye), which Clinica Planas incorporated in 2008, the first center in Europe to have this advanced technology, we can make a diagnosis and subsequent treatment at a high level of precision, being able to sort them by size. In 2016, once again Clínica Planas has taken another step forward in innovation by acquiring the most advanced technology in this field, the new Fluobeam. French scanner technology that allows not only the display but also the flow measurement obtaining the optimal study to indicate the best surgical option for each patient.
Once a microsurgical reconstructive technique as the best option is indicated, we conducted an additional study using a 3 Tesla Magnetic Linforesonance.
Clinica Planas is the first Centre in Europe to incorporate into its Lymphatic Surgery Unit a scanner that allows to localize the lymphatic channels accurately to treat lymphedema. This novel supramicrosurgery technique imported from Japan represents a clear advance in the treatment, obtaining encouraging and satisfactory results. The decrease in swelling of the affected limb and the feeling of heaviness entails an improvement in mobility and quality of life of the affected person.Curriculum