About Lymphoedema

What is lymphoedema?

In a normal person, fluid is lost from the circulation as it passes through the capillaries of a limb. This fluid is recycled back to the venous part of the circulation by a system called the lymphatics. Lymphoedema describes a condition where an excess of fluid builds up in the limbs, usually because of impairment to the outflow of lymphatic fluid from an affected area. Lymphoedema affects different people in different ways, and can cause excessive swelling, restricted movement, pain, recurrent episodes of severe infection (cellulitis), and subsequently a greatly decreased quality of life for the patient. It is very common, with over 100,000 people affected in the UK. By far the most common cause in the UK is the treatment of lymph nodes affected by cancer, by either surgery or radiotherapy. Up to 60% of patients treated for breast cancer and 60% of patients treated for gynaecological cancer are estimated to suffer with lymphoedema.

What causes lymphoedema?

Lymphoedema may be classified as primary or secondary, based on underlying cause. Primary lymphedema is caused by abnormal development of the lymphatic system. It can be present at birth, or develop later in life. Most commonly in the UK, lymphoedema develops secondary to damage to normal lymphatics. The most common causes of lymphedema are lymphatic damage from surgery (axillary or groin lymph node dissection), or radiotherapy. Worldwide, filariasis is the most common cause with damage to the lymphatics. Filariasis is caused by invasion of the lymphatics by a parasite called Wuchereria bancrofti.

What treatments are available for lymphoedema?

Conventional treatment for lymphoedema consists of meticulous skin care, self-massage, and specialist compression bandaging. This is performed by lymphoedema specialist nurses and therapists. At best, this can control the disease, but it fails to address the cause - an obstruction to the outflow of lymph fluid from the affected region. Furthermore, lymphoedema of some areas, for example the head or the scrotum, is not amenable to compression therapy.

What is supermicrosurgery?

Microsurgery describes surgery performed beyond the limits of human sight utilising the operating microscope. Supermicrosurgery takes this concept further, joining together vessels of between 0.2mm and 0.8mm in diameter, using sutures that are thinner than a human hair. This surgery requires high magnification, specialised equipment, and specialist technical expertise and training.

How is supermicrosurgery used in the treatment of lymphoedema?

At the Oxford Lymphoedema Practice, we use the most advanced minimally invasive supermicrosurgical techniques to relieve lymphoedema. Through tiny incisions, often less than 2cm (1 inch) in length, we find lymphatic channels and small veins just beneath the skin. We then connect the lymphatic channels to the veins. This gives the lymphatic fluid an alternative route to escape from the affected area, effectively bypassing the area of damage to the lymphatics.

Does supermicrosurgery work in the treatment of lymphoedema?

Yes. Supermicrosurgery is an effective treatment for established lymphoedema, and also it is effective at preventing lymphoedema in those at high risk of developing it. In the treatment of longstanding advanced lymphoedema, studies have shown that over 80% of people show improvements in their lymphoedema. In ladies undergoing removal of the lymph nodes in their armpit (axillary dissection) for treatment of breast cancer, just 4% of those undergoing supermicrosurgery subsequently developed lymphoedema. Supermicrosurgery has also been shown to be effective in treating lymphoedema in areas that are hard to treat by conventional compression bandaging, such as the scrotum. We have also found that supermicrosurgery vastly reduces the occurrence of infection (cellulitis) in the affected area. Some patients suffer leaking of lymphatic fluid through the skin (lymphorrhoea), and again, supermicrosurgery is extremely effective at treating this distressing problem. Unlike previous surgical treatments that were disfiguring, and fraught with risk and complications, modern supermicrosurgical techniques – though technically demanding – are minimally invasive, and have been shown in numerous studies published in peer reviewed medical journals to be highly effective. Furthermore, supermicrosurgery for lymphoedema has a very low complication rate, with possible complications including infection, lymph leak, and rarely worsening of lymphoedema (though as lymphoedema is a progressive disease this may be failure to interrupt the cycle of worsening lymphatic function).

Lymphoedema in leg

Left leg lymphoedema

Lymphoedema in arm

Left arm lymphoedema