DGPRÄC – Deutschen Gesellschaft der Plastischen,
Rekonstruktiven und Ästhetischen Chirurgen
DGS – Deutsche Gesellschaft für Senologie
GÄCD – Gesellschaft für Ästhetische Chirurgie Deutschland
BSI – Internationale Gesellschaft für Brustchirurgie
ISS – Internationale Gesellschaft für Chirurgie
A lymphoedema blocks the drainage of lymphatic fluid which is normally discharged through the lymphatic vessels. The accumulation of fluid causes chronic swelling and an increase in protein deposits in the tissues. Patients often describe a feeling of tension and heaviness within the affected area. The result is frequently a negative impact on everyday life and therefore on the quality of life in general.
So far, conservative measures such as the complex physical drainage therapy and wearing a surgical stocking were frequently the only options available to patients. The evolution of surgical instruments as well as of electric microscopes and above all of diagnostic imaging has led to the fact that more microsurgeons are entering the field of lymphatic surgery.
There are two types of lymphoedemas: a primary (by birth) and a secondary (acquired) lymphoedema. With secondary lymphoedemas, the affected areas are usually arms and/or legs after tumor operations that entail the removal of the lymph nodes. Approximately, 20% of all women whose lymph nodes have been removed due to breast cancer (especially following the lymph node extraction from level 1 and 2) suffer from problems with the drainage of lymphatic fluids in the arm after the surgery.
In supermicrosurgical lymphatic surgery, a blocked lymphatic vessel is linked to a superficial, small vein. That way, the lymphatic fluid can be transported through the vein and the swelling in the affected areas subsides. The connections (anatomoses) are sutured under the microscope using thread that can hardly be seen with the naked eye. The surgeon needs approx. 45-60 minutes per anastomosis, 3-5 connections are usually required. The lymphatic fluid can run through the newly created lymphovenous anastomosis (LVA). It is drained from the arm and the leg through the venous system which leads to reduced swelling in the affected areas.
It used to be very difficult to find the small, transparent lymphatic vessels. Today, a photodynamic infrared camera (PDE: photo dynamic eye) enables surgeons to visualize the vessels – without any exposure of the patient to radiation.
This method is particularly promising for patients whose lymphoedema has not been in existence for more than 5 years.
Patients have to stay at the clinic for 1-2 days, most patients are released after the first night.