Plastic Surgery Essentials for Students-Chapter 26: Lymphedema

Chapter 26: Lymphedema

Pdf Summary

Lymphedema is a chronic, progressive condition resulting from insufficient drainage of interstitial fluid, leading to swelling in tissues. It affects over 300 million people worldwide, with 90% of cases being secondary, often caused by lymphatic filariasis, and 10% being primary, which is rarer. Primary lymphedema is linked to genetic conditions and can manifest at various life stages, such as Milroy Disease and Meige Disease. Secondary lymphedema may stem from infections, surgical interventions, obesity, or trauma, with lymphatic filariasis being the leading cause in developing nations and post-cancer surgery being a primary concern in developed countries.<br /><br />The pathophysiology of lymphedema involves mechanical disruption of lymphatic flow, leading to protein-rich fluid accumulation, which progresses to fibrosis and tissue thickening. This results in symptoms like pain, swelling, limb heaviness, and frequent infections. Diagnostic methods include nocturnal blood smears, serum assays, imaging techniques like lymphocintigraphy, and MR-lymphangiograms.<br /><br />Management of lymphedema comprises non-operative methods such as limb elevation, compression garments, decongestive therapies, weight management, and skin care, though disease progression is often inevitable even with optimal treatment. Surgical options aim to restore lymphatic function or remove excess tissue and include procedures like lymphaticovenular anastomosis and liposuction.<br /><br />Despite various management strategies, complications like limited mobility, recurrent infections, and potential for malignancy, such as Stewart-Treves Syndrome, pose significant risks. Lymphedema remains a major public health issue, especially as cancer survivorship increases, highlighting the need for effective management and treatment strategies.

Keywords

Lymphedema

Chronic condition

Interstitial fluid

Lymphatic filariasis

Primary lymphedema

Secondary lymphedema

Lymphatic flow disruption

Compression garments

Surgical interventions

Stewart-Treves Syndrome