Commonly used terms in the treatment and management of Lymphoedema
Anastomosis – A new connection between two tubular structures. An example in lymphoedema is between lymphatics and vein (lymphovenous anastomosis)
Antibiotic prophylaxis – This refers to the use of antibiotics to reduce the risk of developing an infection. It is standard for any surgical treatment of lymphoedema to give antibiotics for 5 days to reduce the risk of wound infection. In some patients who have experienced multiple episodes of cellulitis to give long term, low dose antibiotics to reduce the risk of cellulitis occuring. Details of protocols are described in the British Lymphology Society Cellulitis Guidelines that Professor Furniss and Alex Ramsden helped develop.
Axillary lymph nodes – lymph glands in the armpit that drain the arm and breast tissue.
Blue (Patent Blue) – A blue dye used in the mapping of lymphatics during operations. It drains through tissues in the lymphatics and allows a surgeon to rapidly find and assess the function of lymphatics. It is removed from the body by the kidneys and may turn a patients urine a pale blue colour for a few days after the operation.
Channel – A lymphatic channel is a small tube that transports lymph. They are between 0.3 and 0.8mm in size in the limbs and have muscles and valves that pump lymphatic fluid along.
Cellulitis – An acute inflammation of the skin caused by infection. Due to changes in the immune function of the skin, patients with lymphoedema are at a higher risk. This is a serious infection and needs rapid and aggressive treatment with appropriate antibiotics.
Charles operation – This is an old fashioned operation and is now very rarely performed. The tissue with lymphoedema is removed and then skin grafts are used to heal the wound. It is a historic operation as current surgical techniques are a great improvement.
Complex Decongestive Therapy – A combination of non surgical techniques used as the mainstay of lymphoedema therapy by lymphoedema therapists. Includes education, compression garments, manual lymphatic drainage as part of a combination techniques.
Dermal backflow – lymphatic normally moves from the skin (dermis) toward the deep lymphatic channels. Due to changes in pressure and flow in lymphoedema, the fluid can move back up towards the skin in the wrong direction. It is clearly seen on ICG lymphography and is diagnositic of lymphoedema.
Elephantiasis – The most advanced stage of lymphoedema in which massive swelling is combined with significant skin changes.
Edema – American spelling for ‘oedema’. Edema is a medical term for excess fluid in tissues. There are many reasons why edema may develop with lymphoedema just being one.
Fibrosis – The formation of scar tissue leading to a hardening or thickening of tissues. Can be caused by radiotherapy or in advanced lymphoedema.
Filariasis – A disease with a range of symptoms including lymphoedema. Filariasis is caused by a nematode worm parasite called by Wuchereria bancroftii and is endemic in India, China and South-East Asia. It is the commonest cause of lymphoedema worldwide.
Foldi-Vodder Method – a form of Complex Decongestive Therapy (CDT). Initially developed by Vodder in the 1930’s but later updated by Foldi as part of the ‘German school’.
ICG lymphography – Indocyanine Green is a small flourescent molecule that travels in the lymphatic system. The dye can easily be seen with a near infrared camera. This investigation is the cutting edge of lymphatic assessment. It is quick, safe and provides excellent real time mapping and assessment of lymphatic function. It has played a critical role in the assessment of a patient for surgery and can direct lymphatic drainage techniques (flourescene-directed MLD). It is also known as ‘near infra red spectroscopy’.
Inguinal lymphnodes – lymphnodes located in the groin that drain the leg and pubic area.
Intermittent Pneumatic Compression Garment – A mechanical device consisting of a material sleeve with air pockets that inflate in sequence. A limb is placed inside the sleeve and the inflation causes pressure that mimics massage to physically push fluid up and out a limb to reduce its volume.
Leduc method – a method of lymphatic drainage proposed by Albert Leduc in 1973 and an alternative ‘school’ of Complex Decongestive Therapy.
Liposuction for lymphoedema (L4L) – This surgery can produce a massive and permanent volume reduction in an arm or leg affected by lymphoedema.
Lumen – The open space inside a tube where the fluid runs.
Lymph – is a clear watery fluid that has moved into the lymphatic system after bathing the cells. It plays important roles in the immune system and transport of cell debris, bacteria and proteins. It is made from fluid that has been filtered originally from the blood then passed through the tissues of the body. Lymph fluid then moves through the lymphatic channel and lymphnodes to eventually return to the blood and thus completing its journey.
Lymphadenopathy – swelling of lymph nodes. This may indicate infection or tumour.
Lymphangiogram – Injection of radio-opaque dye into the lymphatics which then can be mapped using Xray. Developed by Kinmouth in the 1950s has fallen out of use as it damaged the lymphatics and had a high dose of radiation compared to modern techniques.
Lymphatic Collectors – small lymphatic channels.
Lymphocoele – collection of lymphatic fluid in a newly formed cavity in the body. These can devleop following operations such as lymphadenectomy. The fluid filled cavity is present where the lymphnodes have been removed from as the lymph continues to drain into the surgical wound.
Lymphoedema (or Lymphedema) – Lymphoedema is a disorder of the lymphatic system. People affected by lymphoedema commonly have swelling of an arm or leg, a feeling of heaviness and reduced movement. They may also have pain related to their swelling.
Lymphography – Mapping of the lymphatic system. The newest technique is ICG lymphography.
Lymphology – The study of the lymphatic system and its diseases.
Lymphorrhea – lymphatic fluid that passes through a break in the water proof layer of the skin. This can happen spontaneously or following surgery.
Lymphoscintigraphy – A study of the lymphatic system in which weakly radioactive material is injected into the body. The movement of dye can then be seen using a gamma camera and gives information about lymphatic function. It is expensive, is performed in a nuclear medicine department of a large hospital and has poor resolution. However it can see deep lymphatics and provide a quantitative estimate of dye movement.
Lymphovenous anastomosis (LVA) – This microsurgical bypass operation connects lymphatics to small veins in the skin allowing excess fluid to drain from the affected area.
Manual Lymphatic Drainage – physical drainage of lymphoedema by hand. Techniques by Foldi-Vodder and LeDuc have been described. New techniques such as FD-MLD are refinements on simple massage.
Microsurgery. Surgery performed beyond the ability of the human eye alone. An operating microscope allows extremely small structures to be manipulated and repaired. Supermicrosurgery is operation of structures of less than 1mm in size.
Multiple lymphatico-venular anastomosis. A surgical operation, usually performed under local anaesthetic, where functioning lymphatic channels in the affected arm or leg are joined to small veins, bypassing an area of lymphatic blockage.
Perometry. Measurement of limb volumes using a Perometer machine.
Radiotherapy – treatment of disease by radiation. The radiation damages the DNA in cells. Whilst this kills cancer cells it also damages the lymphatic system in the area treated and is a potent cause of subsequent lymphoedema.
Suction Assisted Protein Lipectomy (SAPL) – This is another name for Liposuction for lymphoedema. SAPL is sometimes used to differentiate this surgery from cosmetic liposuction.
Sclerosis – thickening and fibrosis of a structure. The happens to the wall of a lymphatic vessel due to inflammation and pressure within the vessel, leading to reduced lymphatic flow.
Sentinel lymph node – The first lymphnode to drain a tumour. Modern surgical techniques allow targeted biopsy of this node for assessment. It may prevent a full lymphadenctomy if there is no tumour present. However removal of this single node can still cause lymphoedema.
Thoracic Duct – a large lymphatic channel in the chest that drains into a large vein in the neck. It drains all the lymph from the legs and the gut.
Vascularized lymphnode transfer (VLNT) – The surgical transfer of spare lymphatics from a healthy area of the body to the arm or leg with lymphoedema.
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