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Lymphedema Treatment

The board-certified, fellowship-trained plastic surgeons at The University of Kansas Health System offer the region's only surgical lymphedema treatment program. Lymphedema can occur after trauma or injury, but is most often the result of breast cancer treatment that involves the removal of lymph nodes or after radiation in the armpit of the affected breast.

Lymphedema can occur in the lower extremities as well. The condition is most often seen in patients with bladder, gynecologic or prostate cancers, who have had lymph nodes removed or radiation therapy. Prevention and conservative therapy are the main forms of treating lymphedema. However, early detection is key. Your care team at The University of Kansas Health System uses Sozo to screen for lymphedema. Sozo can detect subtle changes earlier than symptoms appear allowing an opportunity to prevent or reverse lymphedema in many instances. We are the only one in the country that offers a true lymphedema prevention program.

James Butterworth, MD, a plastic surgeon at The University of Kansas Health System, says patients should avoid any blood pressure cuffs, blood draws, IV needles, tattoos, cuts or scrapes to prevent onset or exacerbate lymphedema. Compression sleeves, massage therapy and physical activity, such as yoga, Pilates and lifting light weights, have all been shown to reduce the risk of lymphedema.

Compression sleeves, massage therapy and physical activity, such as yoga, Pilates and lifting light weights, have all been shown to reduce the risk of lymphedema onset.

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Surgery for lymphedema

Microsurgical techniques to treat lymphedema include lymphovenous bypass or lymph node transfer, which may improve lymphatic circulation and decrease symptoms and risk of infection.

The least invasive surgery to treat lymphedema is lymphovenous bypass or lymphaticovenous bypass. This involves injecting dye into the hand to help map lymphatic channels in the body, which are then identified microscopically through small incisions in the arm. Once pinpointed, the channels are redirected into neighboring veins to reroute the lymphatic flow to avoid the obstruction in the armpit.

Lymph node transfer is another surgical option, although it is more invasive and usually reserved for patients who have long-standing lymphedema. Debulking, or the removal of fibro-fatty tissue, is used to treat patients with chronic lymphedema. Liposuction is also frequently used to treat lymphedema. It can remove 1-2 liters of fibro-fatty tissue, allowing the arm to return to its normal size.

The success rates for the 2 most common procedures, lymphovenous bypass and liposuction, are high. The subjective improvement for lymphovenous bypass patients is greater than 90%. Most patients will notice reduced tightness, heaviness, swelling and fatigue in their arm. More than 80% of patients will see a decrease in their arm circumference. Liposuction results are almost immediate, although patients will need to wear a compression sleeve for most of their life.

Lymphedema - surgical operations
More recently, we have been performing surgical operations for the treatment of lymphedema. This can come in the form of two large headings, either a physiological operation or a debulking operation. Physiological operations are done to improve the flow or reroute the flow of lymphatic fluid, and debulking operations are performed in order to reduce the amount of fibrofatty tissue that's built up over the course of years with lymphedema.

The least invasive surgery used to treat lymphedema is called lymphvenous bypass, or lymphaticovenous bypass. This involves using a machine to inject dye into the hand, which helps map out the lymphatic channels. Small incisions are made in the arm, usually about 2 inches in length, and an operating room microscope finds those lymphatic channels. Once found, the channels are routed into neighboring veins to reroute the lymphatic flow to avoid the obstruction in the armpit.

Lymph node transfer is another surgical option, although it is much more invasive and usually reserved for patients who have long-standing lymphedema. Debulking, or the removal of fibro fatty tissue, is used for patients with chronic lymphedema. Liposuction is also frequently used to treat lymphedema. It can remove 1-2 liters of fibro fatty tissue, allowing the arm to return to its normal size.

Lymphedema debulking surgery
The least invasive type of surgery that we do is something called a lymphedema bypass or a lymphaticovenous bypass, depending on the paper that you read. This involves going to the operating room, going under a general anesthetic, and then using a machine with some dye injected into the hand to map out the lymphatic channels. After this, we make small incisions in the arm, usually about two inches in length. And using an operating room microscope, find those lymphatic channels. Once we've found them, we then reroute them into neighboring veins in order to reroute the lymphatic flow to avoid the obstruction that's found up in the axilla or the armpit. Another form of surgical therapy includes lymph node transfers. Lymph node transfers is a much more invasive operation that we usually reserve for people that have had long-standing lymphedema and most likely do not have the lymphatic channels that we can use to reroute. Lastly, as mentioned before, our form of debulking, or removing the fibrofatty tissue is usually used in patients that have chronic lymphedema. These are patients that have had it for a number of years usually. It is unlikely that through a physiological operation alone that we're able to return the size of the arm back towards the other arm. In doing so or in performing one of these debulking procedures, usually it's in the form of liposuction. We can remove one to two liters of this fibrofatty tissue and return the arm back down to its normal size.

The success rates for the two most common procedures, lymphvenous bypass and liposuction, are high. The subjective improvement for lymphvenous bypass patients is greater than 90%. Most patients will notice their arm is less tight, heavy, swollen and fatigued. More than 80% of patients will notice a decrease in the circumference of their arm. Liposuction results are almost immediate, athough patients will be subjected to wearing a compression sleeve for most of their life.

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Turning Point offers free classes, programs and tools designed to empower and educate people affected by chronic or serious illness.

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