Lymphedema refers to build up of fluid in the soft tissues as a result of damage to, interruption of, or disorganization in the lymphatic system. In the United States, the most common origin of a patient’s development of lymphedema is a side effect of necessary treatments for a disease process, such as cancer. When lymph nodes are sampled from armpit or groin regions, this has potential for development of swelling in the limb. This is particularly true when the lymph node removal is necessarily followed by radiation treatment.
In the case of breast cancer, for example, some or all of the lymph nodes may be removed from the armpit region. This alone may result in lymphedema of the arm. Fortunately, sentinel lymph node techniques have greatly reduced the incidence of lymphedema. To reduce risk of local recurrence, the armpit region may be radiated after surgery. While this may reduce the local recurrence rate of cancer in specific cases, it may also increase the incidence of lymphedema.
The initial treatment of lymphedema will be conservative management with a therapist specifically trained in techniques such as massage and wrapping that will help mobilize fluid out of the affected limb. If these measures are not effective or have limited results, the patient may continue to have enlargement of the limb, tightness, discomfort, frequent infections, and displeasure with appearance.
Microsurgical procedures have been successfully used in the management of lymphedema after cancer treatment. There are currently two main microsurgery approaches: vascularized lymph node transfer and lymphovenous bypass.
Vascularized Lymph Node (or Lymph Node Transplant)
The concept for this procedure is to remove scar tissue from the affected wound bed and replaced it with a transfer of lymph node tissue. The donor or harvest sites for this tissue most commonly come from superficial lymph nodes in the low abdominal region, from lymph nodes above the collar bone, or lymph nodes from the back. The tissue placed in the wound bed may require added skin coverage (skin paddle) if the tissue is too tight from previous surgery and radiation.
The lymphatic vessels ultimately empty into the venous system at the base of the neck. If the fluid cannot get past the surgical and/or radiation site, access may be created by directly connecting the small lymphatic channels to small veins in the affected lymph. This bypasses the blockage and creates access to the venous system directly in the arm.
Many insurance providers may consider one or both of these methods to be experimental and not a covered benefit at this time. If you are considered to be a surgical candidate for one of these procedures, it will be important to discover whether or not your insurance provider has a written policy on covered benefits for lymphedema. It is routine for our clinic to initiate a pre-determination or pre-authorization with your insurance provider if you are determined to be a surgical candidate.