Lymphovenous Microsurgical Shunts in Treatment of Lymphedema of Lower Limbs: A 45-year Experience of One Surgeon/One Center.

Dec 2012

Olszewski WL.

Source

Department of Surgical Research & Transplantology, Medical Research Center, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland. Electronic address: wlo@cmdik.pal.pl.

Abstract

RATIONALE:

The use of microsurgical lymphovenous shunts is one of the generally accepted treatments for limb lymphedema.

AIM:

The 45-year personal experience of one surgeon in indications, technique and results of lymphovenous shunt operations in lower limb lymphedema of varying etiology is presented.

MATERIAL:

One thousand three hundred patients were followed up in the period 1966-2011. Patients were classified into groups according to the etiology of lymphedema as postinflammatory/posttraumatic, postsurgical, idiopathic and hyperplastic. Decrease in limb circumference, heaviness and pain, and increase in joint flexing were evaluated.

RESULTS:

The most satisfactory results, reaching 80-100% improvement, were obtained in the congenital non-hereditary hyperplastic lymphedema group, with large lymphatics not previously damaged by infection. Results were also satisfactory in the group of cancer patients after iliac lymphadenectomy, reaching 80%. A less satisfactory outcome was observed in the postinflammatory group, not exceeding 30-40%. In idiopathic lymphedema results were satisfactory in only a few cases.

CONCLUSIONS:

Patients with lymphedema with local segmental obstruction but still partly patent distal lymphatics and without an active inflammatory process in the skin, subcutaneous tissue and lymph vessels present satisfactory results.

**Editor's note:  Please understand this procedure while showing great promise is still classified as experimental.  Also, note the particular "types" of lymphedema and patients that appear to have the best results. See RESULTS - Pat**

PubMed

How to Wrap Legs for Lymphedema

Instructions

1 Arrange all of your necessary supplies nearby. Pre-cut the tape strips to keep one layer of wrapping in place while you are applying the next. Preparation, patience and allowing yourself ample time to perform the wrap are crucial to successfully finishing the procedure.

2 Apply moisturizing body lotion to the skin of your affected leg. This will maintain good skin condition by hydrating the skin and preventing cracking which would enable bacteria to invade your leg, causing infection. It will also help to alleviate potential skin irritation from using the layers of bandages.

3 Apply a tubular stockinette to protect your skin. Depending on your individual condition, you may (or may not) also use flexible gauze over the stockinette.

4 Use the thin foam-like fabric that your therapist gave you. Wrap a layer of padding around your leg. This will help to distribute the compression evenly.

5 Apply the lymphedema bandages, which are also known as short-stretch bandages. Apply more pressure at your foot, gradually decreasing the pressure as you move upward. The narrower bandages can go around your foot with the wider bandages spiraling up your leg. The exact number of bandages necessary will largely depend on the length and size of your leg as well as the amount of compression that you need.

Tips & Warnings

• Other potential treatments all aim to encourage lymph fluids to flow out of the affected leg and include light exercising of the affected leg, massage, pneumatic compression (a special sleeve which connects to a pump to place pressure on the affected leg) and compression garments. Some of the treatments can be combined for CDT (complete decongestant therapy).
• Severe lymphedema may require surgical removal of excess leg tissue to help reduce swelling.
• Avoid wearing socks that constrict your legs and avoid long periods of standing. If you must be on your feet for work, your doctor may recommend wearing compression stockings.
• Do not use ACE bandages as lymphedema wraps. Lymphedema bandages have limited stretching capacity and offer proper skin pressure for aiding the flow of lymph fluid. These special bandages also prevent constriction which can occur with ACE bandages.
• Contact your doctor immediately if you see a rash, redness or have any signs of infection in the affected leg. Do not apply compression or bandaging.
• This article does not take the place of your doctor's guidance or teaching by an experienced therapist. Individualized lessons and supervision are crucial for learning proper technique.


Read more: How to Wrap Legs for Lymphedema | eHow.com