Lymphoedema
Lymphoedema is a chronic condition caused by an accumulation of lymph fluid in the tissues due to a disorder of the lymphatic system. It often occurs in the arms or legs, but can also affect other parts of the body. Lymphoedema can be primary or secondary:
- Primary lymphoedema is less common and is caused by a congenital malfunction of the lymphatic system.
- Secondary lymphoedema is caused by damage to the lymphatic system (due to surgery, radiation, infection or injury). One example of secondary lymphoedema is chronic lymphoedema, which can develop after breast cancer treatment (breast cancer-related lymphoedema, BCRL).
Symptoms
Patients with lymphoedema may suffer from the following symptoms:
- Swelling in the affected areas
- Feeling of heaviness or tightness
- Restricted mobility
- Frequent infections in the affected areas
- Changes in the texture of the skin
Diagnostics
The diagnosis of lymphoedema is usually made by:
- Medical history and physical examination
- Imaging procedures such as lymphoscintigraphy, ICG or MRI
- Measurement of the difference in the circumference of the limbs
Classification of lymphoedema
0 (Latent or subclinical)
No external signs or symptoms visible. Latent changes in the tissue may be present, which can be detected by special examinations.
I (early stage)
Mild swelling that usually disappears during the night or can be reduced by elevation. The skin may indent slightly and return to its normal shape. Occasional discomfort such as a feeling of tightness or pain.
II (middle stage)
Persistent and more difficult to control swelling. Skin may thicken and harden, with wrinkling and changes in skin appearance. More frequent complaints and repeated inflammation.
III (late stage or elephantiasis)
Massive, permanent swelling and deformities. Severely thickened and hardened skin, with deep furrows and wart formation. Chronic inflammation and infection, difficult to treat. Functional limitations and considerable discomfort frequent.
Surgical treatment options for lymphoedema
(Super)microsurgical treatment methods in lymphatic surgery include lymphovenous anastomosis (LVA) and vascularized lymph node transplantation (VLNT). The aim of these procedures is not only to alleviate the symptoms, but also to eliminate the causes of lymphoedema. Visible results on the affected extremities are only achieved after weeks to months.
Stay: 2 to 5 days
Duration: 3-5 hours
Anesthesia: general anesthesia
Stitches: self-dissolving and can be removed after approx. 2 weeks
Postoperative: Compression garment and physiotherapy initially permanent, able to work after approx. 2-4 weeks, sport after approx. 2-4 weeks
Lymphovenous anastomosis (LVA)
In this microsurgical technique, lymphatic vessels are connected directly to small, nearby veins. The aim is to create a new pathway for lymph flow to reduce the swelling caused by lymphoedema. This technique can be particularly effective in the early stages of lymphoedema.
Vascularized lymph node transplantation (VLNT)
In this procedure, lymph nodes are removed from another part of the body where they are present in sufficient numbers and transplanted into the affected area of lymphoedema. The aim is to restore functioning lymphatic drainage in the affected area. This can reduce the swelling.
Liposuction
This method can be used in combination with the microsurgical procedures to remove excess fat and connective tissue that has accumulated in the affected areas. It helps to quickly reduce the size of the affected area and restore the contour.
Surgical therapies are used in combination with conservative therapy. Conservative therapy for lymphoedema, known as Complex Decongestive Therapy (CDT), is a two-phase treatment concept. In the first phase, the intensive phase, the focus is on reducing the swelling through manual lymphatic drainage, compression bandages, exercise therapy and skin care. In the second phase, the maintenance phase, the aim is to maintain the results achieved. Self-management, the use of compression garments and regular check-ups play an important role here.
Lymph-Trial
Around one in eight women will be diagnosed with breast cancer during their lifetime, and around one in five will subsequently develop breast cancer-related lymphoedema (BCRL). At the University Hospital Basel, doctors are not only committed to their patients during the intensive cancer treatment phase, but also offer long-term care and further treatment, e.g. for the side effects of therapy, in order to sustainably improve the quality of life of those affected.
The Lymph-Trial, led by Prof. Elisabeth A. Kappos, aims to improve the quality of life of patients with BCRL. The trial compares surgical with non-surgical treatment of BCRL at international locations in order to gain scientifically sound findings on the effectiveness of microsurgical operations in combination with conservative therapy. People over the age of 18 who have completed/are undergoing breast cancer therapy and suffer from chronic breast cancer-related lymphoedema but have not yet had surgery to treat the lymphoedema are eligible to take part.
Further information on lymphoedema and the Lymph-Trial can be found on the Lymph-Trial website at https://www.lymphtrial.com/.