What is lymphedema?
Lymph nodes are small structures that circulate and filter fluid as part of the immune system. They may be removed in cancer surgery or damaged by radiation therapy or certain types of chemotherapy drugs. This can lead to fluid buildup in the limbs, causing swelling, pain and a heaviness in the affected arm or leg.
Lymphedema is a term used for swelling of your body that can be primary (from no intervention) or secondary (due to a defined cause). In the United States, the most common cause of secondary lymphedema is cancer treatment (surgery to the lymph nodes, radiation therapy, and chemotherapy). Patients are at their highest risk within three years of surgery. However, lymphedema can occur at any point after cancer treatment.
Lymphedema occurs when fluid does not drain properly in the body through lymph vessels and can cause discomfort and swelling, most often of the arm or leg. The limb feels hard, swollen and even heavy in certain circumstances. The presence of lymphedema puts patients additionally at risk for infection.
Conservative Treatment for Lymphedema
Standard treatments for lymphedema are:
- Compression: Using elastic garments like a stretchy fabric bandage or support stocking can help apply pressure to your arm or leg to keep fluid from collecting and help move fluid out to other parts of your body
- Exercise: Stretching can loosen areas that feel tight, hard or heavy and certain movements can help with fluid navigation throughout your body
- Massage: working with our rehabilitation services at OHSU, we are have lymphedema specialists that provide manual lymphatic drainage to move the fluid throughout the body, or soft tissue massage to help loosen scar tissue to relieve discomfort and reduce swelling
- Medication: antibiotics or other prescribed medicine can also be offered to treat lymphedema
We have two LANA-certified lymphedema therapists at OHSU. Our occupational and physical therapists at the Rehabilitation Center at OHSU can help you recognize lymphedema and manage it with massage, compression garments and exercise.
Surgery for lymphedema
Our expert surgeons at the Plastic and Reconstruction Surgery clinic at OHSU are trained in lymphedema and specialize in lymphedema surgery. Because every patient has a different medical history, examination findings and test results, the specialists at OHSU will recommend a treatment plan designed just for you.
For patients with new symptoms of lymphedema, surgery may or may not be necessary. For patients that do undergo surgery to improve drainage of lymphatic fluid, additional treatments like compression, exercise and massage may still be essential to reduce swelling for optimal health.
OHSU’s operative approaches to lymphedema include:
- Lymphovenous bypass: for patients with mild lymphedema, our microsurgery fellowship trained surgeon uses a high powered microscope and superfine micro-instruments to redirect fluid from lymphatic vessels in the affected arm or leg to nearby venous channels. This redirection allows the body to clear the fluid through the venous system.
- Vascularized lymph node transfer: through microsurgery, our specialized, lymphedema-trained surgeons are able to move lymph nodes from other parts of the body to the area of the body affected by lymphedema. This transplant allows drainage of the fluid away from the affected arm or leg.
- Liposuction debulking: for patients with long-lasting or chronic lymphedema, the fluid is replaced over time with fat, which can add to the discomfort of the disease. Our plastic and reconstructive surgery team can offer patients with advanced lymphatic disease liposuction debulking, which can be performed alone or in combination with the other techniques described above.
Knight Cancer Institute Survivorship Program
The Lymphedema Program, spearheaded by the Plastic and Reconstructive Surgery Division of the Department of Surgery, is supported and is an integral part of our Knight Cancer Institute Survivorship Program at OHSU.
OHSU Hemangioma and Vascular Birthmarks Clinic
Lymphatic malformations are complex conditions that are best treated through a multidisciplinary approach. Our plastic and reconstructive surgeons participate in the OHSU Hemangioma and Vascular Birthmarks Clinic, which specializes in the treatment of infants, children, and adults with vascular lesions and birthmarks.