“One procedure is a lymph-to-vein bypass surgery that involves connecting tiny lymph channels in the affected limbs to tiny veins, so blocked up lymph fluids have an outlet to flow into the circulatory system. These connections may be made in multiple locations on the affected limbs during outpatient procedure.
“Another option is lymph node transfer. It involves cutting a wedge of skin tissue containing lymph nodes from one area of the body, often the groin, and transplanting into the affected arm or leg. The transplanted lymph nodes are often able to clear lymph fluid from the affected arm or leg, resulting in partial or full reduction in limb swelling. The procedure requires several days in the hospital.”
“A new approach to treating lymphedema involves transplanting lymph nodes from elsewhere in the body to replace those removed as part of treatment…pioneer a method for selecting lymph nodes for transplant that could minimize this risk…Removing lymph nodes that drain the trunk does not generally cause lymphedema.”
In our area both VLNTx and LVA are being performed by at least one plastic surgeon. He notes however, “Surgery is a treatment option for a very small, selected percentage of the patients who have lymphedema…”
The next question is then, would my wife be one of that small, selected percentage? How is it paid for (ie: does health insurance recognize it as something important or as something cosmetic, that is, “unimportant”)?
To clarify, I should mention that there are TWO systems of fluid transfer in the Human body. The first one we are intimately familiar with called the cardiovascular system – that’s the one that’s connected to our heart and we see every time we cut a finger or scrape a knee. It transfers blood from one part of the body to the other, connects up with the lungs, and general keeps us from dropping dead in sixty seconds!
The lymphatic system is both hidden and for most of us, virtually undetectable. Our Medieval ancestors however, became acutely aware of the lymph system during the Black Death – the plague virus infects the lymphatic system and causes an horrific swelling of the lymph nodes. The nodes were also called “buboes” and the other name for the disease is the Bubonic Plague. Since then, we haven’t paid much attention to it.
It is the nodes, found at the joints – neck, armpits, hips, abdomen, and a few other places – that are removed when there is a suspicion of breast cancer. The nodes, when compressed by our movements, push the lymph from one place to another in the body.
Damage to the lymphatic system does NOT cause death in moments, rather the death from diseases of the lymph nodes and system cause death in terms of months, years, or even decades. The most significant disease to affect the lymphatic system – which also carries white blood cells to injured or infected parts of the body – was the Human Immunodeficiency Virus, more commonly known as HIV. This of course led to the scourge of the 20th Century, Acquired Immune Deficiency Syndrome or AIDS.
It is this parallel system that, when the nodes are removed, causes the buildup of lymph in the extremities. It causes lymphedema.
So there you have it. There is now SOME hope for treating lymphedema; there is now hope for patients whose doctors said, “Oh, don’t worry about injuring the arm we took the lymph nodes from. It’ll be fine…”
It wasn’t fine, and if I could, I would mention to that doctor exactly where he could PUT such saccharine, ineffective, unintelligent, gobbledygook…
UPDATE: 9/1/2018
There seems to be movement and study at the forefront of this surgical practice. The following from a recent article found at https://www.ncbi.nlm.nih.gov/pubmed/29355987: “CONCLUSION: VLNT followed by SAL can allow patients with late Stage II lymphedema achieve near normal limb size and eradication of infectious episodes. At follow-up, these desirable outcomes were maintained well after discontinuation of compression therapy.” (J Surg Oncol. 2018 May;117(6):1148-1156. doi: 10.1002/jso.24969. Epub 2018 Jan 22.)
UPDATE: 8/5/2021: “Gastroepiploic vascularized lymph nodes transfer and lymphaticovenous anastomosis followed by suction lipectomy. CONCLUSION: LVA, VLNT, and SL can be integrated together in a combined approach, in synergy to enhance the outcomes.” (https://onlinelibrary.wiley.com/doi/epdf/10.1002/micr.30641)
Resources: http://www.cancercenter.com/video/treatments-technology/vascularized-lymph-node-transfer/, http://www.advancedreconstruction.com/breast-reconstruction/lymphedema/?gclid=CIr0mNawvs4CFQYOaQodgKYPEQ
Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg
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