When people ask if it’s possible to operate on lymphedema and then never wear a compression garment, I always say yes. Since then, the questions are over. But, as it always happens in surgery, the radical and final treatment can only be performed in the early stages of the disease.
The most effective procedure for lymphedema treatment is lymphovenous anastomosis. The core of the procedure is making a suture, connecting a lymph vessel and a vein.
Patients always think that if most of their lymph nodes were removed, nothing but transplantation would solve their problem. It is not quite so. The lymphatic lymphatic system deteriorates gradually. After removal of lymph nodes vessels keep functioning for some time after. In time the pressure that excesses of lymph exert on the vessels damages them. Usually forearm, hand, or shoulder suffers the most. As they are the finest vessels. That’s why it is so important to make an additional pathway for lymph drainage while it is an early stage of lymphedema and there are some intact lymph vessels.
To make a proper anastomosis it is crucial to identify an area where the vessel is not damaged to suture it with a vein in the right place. You cannot make it with bare eyes. To do this a surgeon needs a fluorescent lymphography with green indocyanine.
Then with 18-30 times magnification using a surgical microscope a surgeon makes a microsuture of a lymph vessel and a vein. That’s how anastomosis is made. Usually, I make two anastomoses, rarely there’s a chance to make three, and rarely – four.
For the patient, this is the most safe and comfortable procedure. It is done under local anesthesia through a minute 2 cm incision. The patient is discharged on the same day with no redressing or sutures removing. No bandages, sutures or drains.
You need to wear knitwear after surgery. It is obligatory to wear compression garments for at least 3 months after surgery to provide a lymph system a proper healing. Then it can be removed gradually for a couple of hours daily to see if there’s a swelling. In this fashion, we get rid of the garments gradually.
There’s an important thing about lymphovenous anastomosis – it has very strict indications. It definitely would not be effective in every patient. It works only if there are intact lymph vessels left. To assess the function of those vessels a fluorescent lymphograp must be performed. If a limb circumference difference is more than 2 cm, the results of lymphovenous anastomosis decrease dramatically.
Don’t waste your time! A diagnostics and treatment made on time help to improve results, save money and time.