Lymphedema is a chronic and debilitating disease that may cause functional disability due to extremity swelling as well as potential complications including dry and cracked skin, non-healing wounds and infection. Management of advanced lymphedema cases is challenging. Conservative measures such as lymphatic massage and bandaging have limited effect and most patients require surgery. Surgical procedures may be divided into physiological procedures in which lymphatic drainage is recreated or bypassed, and resection procedures that remove the affected tissues, or a combination of both.
The modified Charles procedure is particularly useful for the treatment of advanced lower extremity lymphedema and provides definitive and long-term reduction of the excess tissue. This procedure removes all the involved subcutaneous fat and dysfunctional lymphatic tissue while preserving the underlying muscle. Because the muscles are preserved and the excess tissue weight is removed, the majority of patients experience significant functional improvement following surgery. Patients immediately experience relief of the additional weight following surgery. Patients are also free of skin infections that occur frequently in cases of chronic lymphedema. Many are happy to be able to wear normal clothing and restore their social lives that have been previously hampered by the extremity swelling. With the modified Charles procedure, there is no long-term recurrence of the lymphedema and this gives patients long-term assurance of their recovery.
Twenty percent of patients who undergo axillary lymph node clearance develop lymphedema, which is a chronic and progressive condition that significant impacts one’s quality of life. Immediate lymphatic reconstruction – performed at the time of lymph node dissection – is a promising surgical option that is increasingly utilised for the prevention of breast-cancer related lymphedema.
Vascularized Lymph Node Transfer (VLNT) is one of the most advanced techniques we have in the treatment of both primary and secondary lymphedema. The process involves transplanting fresh lymph nodes from a part of the body that does not require them into the region of lymphedema, stimulating the growth of new lymphatic channels by truly replacing like with like. There are a multitude of VLNT donor sites available, and your surgeon will discuss which donor and recipient site is most suitable for you. Results, though requiring some time to develop, can be dramatic.
Lymphedema is a chronic debilitating condition that is best treated at the early stages of the disease. It is caused by an obstruction of lymphatic flow resulting is increasing swelling, recurrent infection and severe fibrosis of the skin.
Lymphovenous bypass is a supermicrosurgical technique that seeks to relieve this obstruction through creating a bypass channel from the lymphatic vessels to the small venules. It works best in the early stages of the disease and is associated with minimal morbidity.
Lymphedema is a complication that can affect patients who undergo axillary dissection as part of surgery for breast cancer and has a lifelong effect on the quality of life of our breast cancer survivors. Establishing a practice of close collaboration with our physio and occupational therapists and our plastic surgeons as well as empowerment of patients with the knowledge of early recognition of symptoms is the key to successful management of these patients.
In the past, lymphedema was often considered untreatable. Disease progression led to long-term physical and psychosocial consequences for the patient. Now, this is no longer true…new microsurgical techniques have challenged this misconception and given hope to many patients.
The Lymphedema Society is the embodiment of the ideal multi disciplinary approach to managing the recalcitrant issue.
The assembly of surgical, medical and auxillary specialties aims to give the best care to lymphedema patients.
Lymphedema is often under-recognized and many individuals suffer quietly being uninformed. We want to reassure you that there are conservative and surgical treatments available.
Lymphedema is a debilitating condition that impairs patient’s quality of life. Early recognition and appropriate intervention play a crucial role in improving patient’s clinic outcome and quality of life. Physiotherapy intervention includes Manual Lymphatic Drainage or Complex Decongestive Therapy, education on self care as well as prescribing use of appropriate compression garment for long term management.
Self-management is the key to lymphedema maintenance. Wearing a compression garment, carrying out self-drainage and exercising are essential parts of self-management.
Self-care is paramount to prevent detoriation and complications in lymphedema. We have produced these videos to teach you how to apply compression bandaging at home and how to correctly wear your compression sleeves or stockings.
Effective and prompt treatment of lymphedema can consistently improve a patient’s quality of life. The role of the physiotherapist is to educate patients on self-care management, administer manual lymphatic drainage, followed by compression bandaging and pressure garment fitting.
Surgery and radiation therapy for breast cancer may result in lymphedema of the arm. Although uncommon, this condition is distressing to our patients who experience it. Today, there are many ways to effectively manage the discomfort of lymphedema. Early diagnosis is key.
Advances in surgical techniques have opened up new treatment options for many patients. The focus is increasingly on intervention at an earlier or preventative stage to prevent disease deterioration and improve quality of life. Minimally invasive surgery allows fast recovery with minimal side effects.
Clients with lymphedema routinely experience disruption in performing meaningful activities, tasks and roles. Occupational therapists trained in the management of lymphedema work through with them to integrate lymphedema self-management strategies to overcome these challenges; supporting them to maintain or increase their independence in their daily living.
The lymphedema service was initiated in 1992 when breast care nurses collaborated with rehabilitative therapists to treat breast cancer patients with lymphedema. The team began to educate patients immediately after surgery with the aim of reducing the incidence of lymphedema. Self-care was emphasized, and the patients also gathered for group exercises. This program, together with the advent of sentinel node biopsy, has seen encouraging results.
Lymphedema is an often misunderstood disease that causes much untold suffering and morbidity to our patients. The formation of the Lymphedema Society of Singapore is most timely and needed for best practices and general awareness of this condition to disseminate. These professionals have led the field in Singapore with their expertise and interest. It represents a very positive step forward for lymphedema related activities going forward.
