What is it?
Lymphedema is a chronic disease characterized by the accumulation of lymphatic fluid in the body, causing swelling. The chronic, progressive accumulation of protein-rich fluid within the interstitium and the fibro-adipose tissue formation exceeds the capacity of the lymphatic system to transport the fluid, leading to skin and tissue changes. It can affect any part of the body, but it is more common in the extremities, and is clinically characterized by chronic gross swelling of the affected limb, localized pain, atrophic skin changes and susceptibility to infections.
Lymphedema is either primary or secondary in nature:
- Secondary lymphedema results from insult, injury, or obstruction to the lymphatic system, primarily due to filariasis (90 million patients), damage to the lymphatic system caused by malignancy, surgery, trauma, infection or radiation therapy (10 million patients) leading to obstruction or disruption of the system.
Limbs are mostly affected, significantly affecting patients' quality of life.
Lymphedema is rarely fatal, but it is a disabling disorder causing significant morbidity and its management is very demanding.
Which are the symptoms?
- feeling of fullness and tightness
- changes in the skin
- skin infections (cellulitis)
- leakage through the skin
- cancer (rare)
How is it diagnosed?
It is obviously important to discover the cause of the lyphedema, but it is also mandatory to define the type of lymphatic abnormality. Imaging tests are used to help diagnose, define and monitor lymphoedema.
How is it treated?
Surgery is considered if other nonsurgical treatments aren’t effective. Not everyone is a candidate for surgery, but for some patients symptoms can be eased with a surgical procedure. Surgical procedures for lymphedema are divided in ablative and physiologic. In ablative surgery, the soft tissues, which are edematous and fibrotic, above the level of the deep fascia, are surgically removed with either direct excision or by liposuction,
Physiologic methods aim to recreate normal lymphatic patterns or alternative ways for lymph fluid to flow out of the affected limb. Two main physiologic procedures are currently considered effective to treat lymphedema. One is based on the creation of shunts between the congested lymphatic channels and the venous system proximal to the site of lymphatic obstruction. The other relies on the introduction of vascularized adipose tissue flaps which include vascularized lymph nodes to the affected extremity.
Where do we treat it?
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