Lymphoedema

Improved quality of life through holistic treatment at the Millesi Center

Lymphoedema is a dysfunction of the lymphatic system that leads to an accumulation of lymph fluid in the tissue under the skin. This disorder can lead to swelling, pain, infection and impaired mobility, most commonly in the arms and legs. At the Millesi Center, we specialize in the surgical treatment of lymphedema to provide our patients with the best possible surgical care and maximize their functional recovery.

Our experienced surgical team works according to a comprehensive treatment concept based on the expertise and many years of experience of Prof. Hanno Millesi. The latest scientific findings are constantly incorporated into the further development of our treatment approaches. As part of the Wiener Privatklinik, we are not only equipped with state-of-the-art facilities, but also offer a comprehensive range of services.

These are the causes of lymphoedema

Lymphoedema has various causes. These include

• Injuries to the lymph vessels
• Surgery in the area of the lymph vessels (e.g. after cancer)
• Irradiation of tumors
• chemotherapy
• Chronic venous dysfunction
• Congenital disorders of the lymphatic system

Symptoms of lymphoedema

Those affected by lymphoedema suffer from

• Swelling of the affected region
• a feeling of heaviness
• Tension or pressure pain
• itching
• recurring inflammation

If lymphoedema is not treated, it can lead to serious health problems, such as skin infections or deformation of the affected limb.

Types of lymphoedema

Lymphoedema can be primary or secondary. Primary lymphoedema is congenital, rare and usually associated with genetic diseases. Secondary lymphoedema is by far the more common form in Europe and can be caused by an injury, an illness or an operation as an undesirable consequence/complication.

PRIMARY LYMPHOEDEMA

Primary lymphoedema is caused by malformations in the development of parts or all of the lymphatic system. In most cases one limb is affected, rarely both. In many cases, primary lymphoedema is associated with other genetic diseases.

SECONDARY LYMPHOEDEMA

Secondary lymphoedema usually occurs

• as an undesirable consequence/complication of an illness, e.g. breast cancer (20-40%), prostate cancer (10-20%)
• after surgical procedures, e.g. after radical prostatectomy and/or lymph node removal (lymphadenectomies)
• after radiation therapy due to some chemotherapies due to chronic venous insufficiency
• due to skin diseases such as erysipelas, lymphangitis or cellulitis as a consequence of a parasitic disease
• due to obesity

How lymphoedema develops

Lymphoedema develops in four stages:

• Stage I: The lymphatic system is impaired but does not yet produce any symptoms.
• Stage II: The lymphoedema is clearly pronounced, but can be partially reduced by elevating the affected part of the body.
• Stage III: At this stage, the lymphoedema has already become chronic and can no longer be reduced by elevation.
• Stage IV: The affected area of the body is misshapen, tense and painful to the touch. Poorly healing wounds and chronic inflammation are also common.

How the diagnosis is made

Lymphoedema is diagnosed in several steps. First, we carry out a clinical examination. Lymphatic scintigraphy is currently the diagnostic gold standard to support and, above all, plan a surgical treatment strategy. Magnetic resonance lymphangiography and/or a high-resolution ultrasound examination may be necessary to visualize the lymphatic unit more precisely. In addition, a special dye, namely indocyanine green (ICG), is introduced into the lymphatic vessels prior to a planned reconstruction of the lymphatic system, making them visible with a camera. This allows the surgical strategy to be planned most precisely.

The treatment of lymphoedema

In the vast majority of cases, lymphoedema is very unpleasant and restricts the quality of everyday life to varying degrees. Depending on the severity of the lymphoedema and the patient’s general state of health, the following treatment options are available as part of the initial treatment and as accompanying measures:

COMPLEX PHYSICAL DECONGESTIVE THERAPY (KPE)

Complex physical decongestive therapy is usually already carried out regularly by those affected in order to reduce the level of suffering, at least temporarily. This type of therapy includes manual lymphatic drainage, bandaging, compression garments, special skin care and hygiene measures as well as exercise therapy.

NUTRITIONAL ADVICE

In addition to conservative and surgical measures, lymphoedema patients require a special and individually tailored diet, which can be provided by trained and experienced nutritionists.

SUPERMICROSURGICAL SURGICAL INTERVENTIONS

Surgical therapies for lymphoedema can help to halt the progression of the disease and alleviate the symptoms. In some cases, surgery can even lead to complete regression of the lymphoedema and normalization of lymphatic drainage. Based on super microsurgery, we are technically able to restore the function of the lymphatic system.

OUR SURGICAL TECHNICAL BASIS – SUPERMICROSURGERY

Super microsurgery is a further development of microsurgery, which makes it possible to dissect and suture together vessel diameters of less than 1 mm. This requires not only specially manufactured, super-fine instruments, but also extremely high-resolution microscopes (up to 70x magnification). The suture materials required for this are smaller than 0.1 mm. The instruments are also especially fine, manufactured precisely for such procedures and purchased by the private clinic in Vienna. The Vienna Private Clinic is currently the only clinic in Europe to have a special microscope that allows us to perform these delicate and difficult operations. With the help of this microscope, we are able to visualize the successful result of the operation using a special dye during the super-microsurgical procedure. Depending on the individual situation and the clinical severity of the lymphoedema, we offer a variety of surgical methods:

A) LYMPHOVENOUS ANASTOMOSIS / LVA

In order to avoid a local drainage problem, it is possible to reconstruct the outflow of lymph by suturing several lymphatic vessels to superficial veins using super-microsurgical surgical techniques. Patients with stage I and II lymphoedema are suitable for this surgical method.

B) LYMPH NODE TRANSFER

Healthy lymph nodes can be transplanted into a congested lymph drainage area and connected to an arterial supply and a venous drainage system using super-microsurgical surgical methods. The transplanted lymph node thus takes over the drainage of the lymph fluid. Lymphovenous anastomoses can in some cases, such as in stage III, be combined with a lymph node transfer.

C) LYMPHOZELES

Lymphoceles usually develop as a result of surgical interventions, after which the lymphatic fluid flows freely into the tissue and thus accumulates. Lymphoceles usually disappear after a few weeks. In cases of persistent lymphoceles, the lymph flow can be re-established by means of LVA (lymphovenous anastomosis) using super-microsurgical operating techniques.

Under these conditions, we can help you: Are you suffering from lymphoedema, regardless of the cause, are you looking for a permanent restoration of the disturbed lymphatic drainage and would prefer to gradually move away from complex physical decongestion therapy or at least reduce it? Following a detailed clinical examination and review of your findings, we will advise you on the available surgical options and draw up a complete treatment plan for you.

FAQ

IS LYMPHOEDEMA COMPLETELY CURABLE?

At an early stage, lymphoedema can be significantly improved or even eliminated in many cases by means of supermicrosurgery. In many cases, complex decongestive therapy can also be omitted.

WHAT IS THE FOLLOW-UP TREATMENT AFTER LYMPHOEDEMA SURGERY?

Depending on the reconstructive surgical method, rapid post-operative mobilization and supportive resumption of complex decongestive therapy will take place.

HOW LONG IS THE HOSPITAL STAY FOR LYMPHOEDEMA?

In the case of a lymphovenous anastomosis, patients should expect to stay in hospital for two to three days. For a microvascular lymph node transfer, a hospital stay of five to seven days can be expected.

WHAT CAN I DO TO PREVENT MY LYMPHOEDEMA FROM GETTING WORSE?

Consistent complex decongestive therapy and nutritional therapy have a supportive effect. However, if the cause of the lymphoedema that has developed is not remedied, the lymphoedema will progress as a chronic disease.

IS SURGERY FOR LYMPHOEDEMA ABSOLUTELY NECESSARY IN EVERY CASE?

Unfortunately, impaired lymphatic drainage increases in severity as the condition progresses and becomes chronic. More and more lymph vessels are affected. Surgical reconstruction using supermicrosurgical methods is currently the only option for permanent improvement.