What Is Involved in Lymphedema Surgery?

It refers to the soft tissue fluid caused by the obstruction of lymphatic fluid return in some parts of the body. After repeated infection of the body surface, the subcutaneous fibrous connective tissue proliferates and the fat hardens. If the limb is thickened. In the later period, the skin thickened, rough, and tough like elephant skin, also known as "skin swollen".

Basic Information

nickname

Elephantiasis

English name

Lymphedema

Visiting department

Hematology

Common causes

Caused by lymphatic obstruction or lymph node disease

Common symptoms

Hyperplasia of skin and subcutaneous tissue, deepening of skin wrinkles, thickening, hardening, and roughening of the skin, with spines and wart-like protrusions, which look like elephant skin

Causes of Lymphedema

Primary lymphedema

(1) Congenital, simple hereditary.

(2) The types of early-onset primary lymphedema can be classified as follows: Lymphatic hypoplasia with absent subcutaneous lymph; Lymphatic hypoplasia, small and few lymph nodes and lymphatic vessels; Hyperplasia of lymph, with large lymph nodes and lymphatic vessels And often, there are distortions and flexures.

Lymphatic dysplasia is very rare, and it is common in congenital lymphedema. Underdevelopment is the most common type. Simple and ordered lymphedema are congenital. Early-onset lymphedema is more common in adolescent women or young women, and symptoms worsen during menstruation, so it is speculated that the cause may be related to endocrine disorders, accounting for 85% to 90% of primary lymphedema. Onset after age 35 is called delayed lymphedema.

2. Secondary lymphedema

(1) Infectious parasites, bacteria, fungi, etc.

(2) Traumatic surgery, radiotherapy, burns, etc.

(3) Malignant tumor Primary tumor and secondary tumor.

(4) Other systemic diseases, pregnancy, etc.

Lymphedema clinical manifestations

Hyperplasia of the skin and subcutaneous tissue, deepening of skin wrinkles, thickening and hardening of the skin, and may have spines and wart-like protrusions, which look like elephant skin. Early swelling of the affected limb can be relieved after elevation. In the later stage, the affected limbs became swollen obviously, and the surface keratinization was rough, showing a rubber-like swelling. A few may have cracked skin, ulcers, or verrucous vegetation.

Lymphedema

1. Analysis of diagnostic puncture fluid

The analysis of subcutaneous edema tissue fluid is helpful for the differential diagnosis of difficult cases. Examination is usually used for chronic large and swollen limbs, which can be operated with only a syringe and a fine needle. The method is simple and convenient.

2. Lymphangiography

Lymphatic puncture is injected with contrast agent, and the radiograph shows a method of examining the morphology of the lymphatic system.

3. Isotope lymphangiography

Lymphangiography does not provide quantitative kinetic data on the function of the lymphatic system, nor can it provide simple information on lymphatic drainage from different limb parts. Therefore, a valuable static intralymphatic glare imaging (nuclides imaging) is currently being developed. Inject 0.25ml (75MBq) of sham chain sulfide gel into the subcutaneous tissue of the second toe web of the feet. The r camera was used to scan the patient's lower abdomen and groin area, and the static image scans were performed at 1/2, 1, 2, and 3 hours, respectively, and the isotope uptake of the iliac inguinal nodes was calculated. Isotope imaging was used to study the lymphatic function of chronic lymphedema, suggesting that the reduction of lymphatic reflux in the affected limb is related to the severity of lymphedema. In severe lymphedema, the isotope uptake rate is almost zero, and the percentage of lymphatic uptake in venous venous edema increases significantly.

4. Other inspections

In addition, ultrasound vascular non-invasive detection technology is also helpful for the identification of venous edema and lymphedema. As an outpatient screening method, it is simple and convenient.

Lymphedema diagnosis

A history of filarial infection or recurrent erysipelas, or a history of lymph node dissection and radiation therapy in the axilla and groin. In the later stage, the affected limbs became swollen obviously, and the surface keratinization was rough, showing a rubber-like swelling. A few may have cracked skin, ulcers, or verrucous vegetation. Microfilariae can be found in blood tests around people infected with filariasis. Lymphangiography can identify lymphatic development or obstruction. If necessary, a lymph node biopsy confirms the diagnosis.

Lymphedema Treatment

Lymphedema is treated differently according to the course of the disease. In the early stage, the purpose is to exclude stagnant lymphatic fluid and prevent the regeneration of lymphatic fluid. In the later stage, surgical resection of irrecoverable diseased tissue or shunting is used to treat localized lymphatic obstruction.

1. Acute lymphedema

Mainly non-surgical treatment.

(1) Postural drainage The drooping state of the lower limbs makes the retention of lymph fluid in the interstitial space worse. Elevating the affected limbs by 30 to 40 cm can promote lymphatic reflux and reduce edema.

(2) Compression bandaging Based on postural drainage, when the affected limb is elevated, compression bandaging with elastic socks or elastic bandages is used to squeeze the tissue gap and assist lymphatic reflux. It can also be used multiple times and for a long time with the gap pressure device, which has a certain effect on improving edema.

(3) Limit the intake of sodium salts and use of diuretics. In the acute phase, appropriately limit the intake of sodium chloride, usually 1-2 g / day, to reduce tissue sodium and water retention. At the same time use an appropriate amount of diuretics to accelerate water and sodium excretion. Dihydrogram urine thiazide is available 3 times a day, and potassium is appropriately added.

(4) Antifungal ointments and powders are used to prevent infection . Keeping your toes dry is the most effective way to prevent and control fungal infections. Bacterial infections under the toenails are also common. You should cut your toenails to remove dirt and reduce bacteria. Way of invasion. When systemic symptoms of streptococcal infection, drugs such as penicillin should be used. Advanced lymphedema and skin chapped can be applied externally to protect and lubricate the skin.

Foreign scholars have proved that when the typhoid triple vaccine is injected, the number of lymphocytes in the lymphatic vessels is increased, the gamma globulin in the blood is also increased, and it has the effect of preventing permanent lymphatic obstruction.

2. chronic lymphedema

Including non-surgical treatment and various kinds of surgical treatment.

(1) Drying therapy The drying therapy is a treatment method to discover the medical heritage of the motherland. The treatment principle is to use continuous radiant heat to expand the skin and blood vessels of the affected limb, sweat a lot, and return the liquid in the local tissue space to the blood to improve lymph circulation.

(2) Surgical treatment About 15% of primary lymphedema will eventually require lower limb plastic surgery. None of the existing surgical methods can cure lymphedema, but it can obviously improve the symptoms.