Vascularized Lymph Node Transfers

WHAT IS LYMPHEDEMA?

During surgery for cancer, the doctor might remove one or more lymph (limf) nodes from the affected area to see if the cancer has spread. When lymph nodes are removed, lymph vessels that carry fluid from the affected area to the rest of the body are also removed because they route through and are wrapped around the nodes.

Removing lymph nodes and vessels changes the flow of lymph fluid in the affected areas of the body. This makes it harder for fluid to flow out of these areas. If the remaining lymph vessels cannot drain enough fluid from these areas, the excess fluid builds up and causes swelling, or lymphedema (limf-uh-dee-muh). Radiation treatment to the lymph nodes can affect lymph fluid flow by causing scarring and damage, further increasing the risk of lymphedema.

Lymphedema is a build-up of lymph fluid in the fatty tissues just under your skin. It usually develops slowly over time. The swelling can range from mild to severe. It can start soon after surgery or radiation treatment. But it can also begin months or even many years later. Patients who have many lymph nodes removed and patients who have had radiation therapy for cancer have a higher risk of getting lymphedema.

Unfortunately, no definitive treatment for lymphedema exists. The current mainstay of lymphedema management is complex decongestive therapy (CDT) and compressive garments. Although effective in many patients, CDT is time consuming, difficult to perform on a regular basis, expensive and can lead to high rates of noncompliance and patient dissatisfaction.

LYMPHOVENOUS BYPASS

Dr. Del Corral is one of the only microsurgeons in the region offering lymphovenous bypass and lymph node transfer, innovative surgical techniques designed to reduce swelling and alleviate discomfort for patients with lymphedema.

Dr. Del Corral performs a lymphaticovenular bypass, a variation of lymphovenous bypass. The main difference of this operation is that it connects the superficial veins to superficial lymphatic with similar pressure. This avoids the risk of venous reflux associated with traditional lymphovenous bypass. In this procedure supermicrosurgery techniques are used. Two to five small incisions measuring an inch or less are made in the arm or leg using tiny microsurgical tools. Dr. Del Corral redirects the lymphatic fluid to small veins (venules) to allow for drainage, thus alleviating lymphedema. The procedure takes about two to four hours under general anesthesia. The hospital stay is less than 24 hours.

VASCULARIZED LYMPH NODE TRANSFERS

For many years, lymphedema has been primarily been treated with a combination of massage therapy, compression therapy, liposuction and skin care. This new procedure called vascularized lymh node transfer offers a significant improvement of this condition.

A vascularized lymph node transfer (VLNTx) is a microsurgical procedure where normal lymph nodes and their associated adipose tissue is transferred to a region of the body that suffers from lymphedema as a means to:

  • Decrease limb size
  • Alleviate subjective symptoms of heaviness, achiness and early fatigue
  • Potentially reduce daily compression requirements
  • Slow progression of the disease
  • Potentially reducing episodes of cellulitis or infections

Lymph nodes usually are harvested from the groin, axilla or supra-clavicular (above the clavicle) area with their supporting artery and vein and moved to the recipient site like the armpit or the groin to help drain the swollen limb. Using specialized microsurgical techniques, Dr. Del Corral then reconnects the artery and vein to recipient blood vessels to provide vital support to the lymph nodes during the initial healing phase. Vascularized lymph node transfers can also be performed during a DIEP or MsTRAM free flap. At the time of removing the abdominal tissue (abdominal flap) to reconstruct the breast, adjacent superficial groin lymphatics are harvested with the flap. This allows for simultaneous breast reconstruction and improvement of the lymphedema in one operation. This operation can also be used to help patients with leg lymphedema, by transferring healthy vascularized lymph nodes to the groin or the foot.

After surgery you may need to receive manual lymphatic therapy or wear compression garments. Not everyone is a candidate for a vascularized lymph node Transfer. During you visit Dr. Del Corral will evaluate if you are an ideal surgical candidate for this operation.