Lymphostasis

For us, treating lymphostasis is a matter of heart. The treatment should be started as soon as swelling appears!

• Compression treatment is the cornerstone of conservative treatment
• In surgical treatment, the swollen tissue is either removed (liposuction) or the lymphatic drainage is directed into the vein circulation or alternatively healthy lymph nodes are microsurgically implanted into the affected area

General information on how to treat lymphostasis

Lympha is protein fluid that filters from blood vessels to the subcutaneous tissue. From the tissue the fluid is then transported through lymph ducts into the lymph nodes (sentinel nodes) which act as defenders for our immune system.

Finally, the extra fluid returns to the vein circulation through the lymphatic system.

Globally, the most common causes for disruption in lymphatic circulation (lymphostasis) are soft tissue infections (f.ex. filariasis). It can also be a congenital lymph node deficiency. In the western society, the most common causes of lymphostasis are cancer diseases.

They spread through the lymphatic system (breast cancer, melanoma, gynaecological cancers) and when treating, operation and radiation radically reduces the amount of lymph nodes.

Overweight can also cause the lymph circulation swelling as well as a serious case of varicose veins in the lower limbs.

Conservative care

Due to improvement in the operating techniques and radiation therapy quality, the lymph circulation disturbance is usually mild. Conservative treatment of the swelling is usually helpful enough. Compression treatment is the cornerstone of the treatment.

Manual lymph therapy and body massage LPG treatment are important factors in treating lymphostasis. Tailor made compression sleeves always need to be worn. Exercising, elevated positioning and losing weight help a lot.

Surgical treatment

In case the conservative approach does not reduce lymphostasis, surgical treatment can be considered even in the early stages.

Liposuction decreases the number of swollen fat cells and can be of sufficient help. Usually, the compression sleeve should still be worn continuously. Preparations for liposuction should be done with care. The skin must be intact, a preventive course of antibiotics is important as is the prevention of bleeding in aftercare.

In case of serious lymphostasis it is worth considering microvascular implantation of lymph nodes or microsurgical reconstruction of the lymphovenous fistulae.
For breast cancer patient who suffers from post-mastectomy and armpit evacuation hand swelling, it is ideal to perform a lymph node transplantation in conjunction with the breast reconstruction (MS-TRAM, muscle-sparing transverse rectus abdominis myocutaneous) surgery. The lymph nodes are taken from the groin area and transplanted into the operated armpit with blood vessels. The transplantation can be done also without breast reconstruction, but luckily in breast-conserving surgery, the patient rarely suffers from serious swelling.

Our head plastic surgeon Helena Puonti is widely experienced in microsurgery and breast reconstruction with a microneurovascular abdomen flap with necessary lymph node transplantation. The patient needs to be relatively healthy to ensure proper healing from the demanding surgery.

In the past lymphovenous fistulae operations did not produce good results. Supposedly the chronic swelling had already caused severe skin and subcutaneous tissue thickening where only surgical removal of the subcutaneous tissue and skin transplants could ease the swelling.

As the techniques have improved, lymphovenous fistulae operation has newly become a popular method. It needs to be performed at a relatively early stage before the situation in the hand becomes chronical. With the aid of a microscope, a small lymph node is attached to the vein. In case of arm swelling, lymphovenous fistulaes are sewn into the wrist area, in case of shoulder swelling also into the bend of the arm.

Our plastic surgeon Helena Puonti has a special interest in improving the lymphatic circulation and she has been working on a fix to the problem for over 20 years.