Plastic Surgery Essentials for Students-Chapter 27: Lymphedema

Chapter 27: Lymphedema

Pdf Summary

Lymphedema is a chronic, progressive swelling of soft tissues caused by impaired drainage of lymphatic fluid, affecting over 300 million people globally. It can be primary (due to congenital lymphatic abnormalities, e.g., Milroy or Meige disease) or secondary (more common, from acquired damage such as cancer treatment, infections like lymphatic filariasis, trauma, or obesity). Secondary lymphedema is prevalent post-cancer therapies disrupting lymph nodes, especially breast, prostate, and gynecological cancers.<br /><br />Pathophysiologically, lymphatic disruption leads to accumulation of protein-rich interstitial fluid, inflammation, fibrosis, fat deposition, and skin changes from early pitting to late non-pitting edema. Diagnosis distinguishes lymphedema from other causes of limb swelling (e.g., cardiac, renal, venous insufficiency, lipedema) through history, physical exam, limb measurements, and imaging. Lymphoscintigraphy is the gold standard imaging; MR lymphangiography and indocyanine green (ICG) lymphography offer detailed assessment useful for surgical planning.<br /><br />Clinically, lymphedema presents with swelling, heaviness, functional impairment, recurrent infections, and skin changes. The International Society of Lymphology classifies lymphedema into stages 0 to III, from latent dysfunction to elephantiasis with severe skin alterations.<br /><br />Management begins with 3-6 months of conservative measures—complete decongestive therapy (manual lymphatic drainage, compression garments, exercise), weight loss, skin care, and antiparasitics if filariasis is present. Surgery is considered for refractory cases or those with complications. Physiologic surgeries include lymphaticovenular anastomosis (LVA) and vascularized lymph node transfer (VLNT) to restore lymphatic flow, with VLNT favored in advanced stages. Reductive surgeries (liposuction, Charles procedure) remove fibroadipose tissue in severe disease.<br /><br />Complications include functional disability, infections, chronic wounds, and rare malignancy (Stewart-Treves syndrome). Surgical risks involve lymphatic failure, donor-site lymphedema, and operative complications. Multidisciplinary care and follow-up optimize outcomes. This comprehensive overview highlights the importance of early diagnosis, tailored therapy, and emerging surgical approaches to improve patient quality of life.

Keywords

Lymphedema

Chronic swelling

Lymphatic fluid drainage

Primary lymphedema

Secondary lymphedema

Lymphoscintigraphy

Complete decongestive therapy

Lymphaticovenular anastomosis

Vascularized lymph node transfer

Stewart-Treves syndrome