Lymphodema and LDEX

Lymphedema is condition of restricted drainage of the lymph circulation. Lymph is the non- cellular plasma component of the blood. When the blood circulates through the body it passes through smaller and smaller blood vessels finally traversing the capillaries. Here the nutrients are passed to our cells and oxygen is released to our tissues. The blood cells have to line up single file through the capillaries and the plasma or lymph separates from the blood. The blood and some plasma returns to the heart and lungs through the venous system, but the separated lymph returns through a separate system passing through lymph nodes or filters along the way. The lymph nodes are part of our immune system and function to process foreign proteins to stimulate antibody production. Cancer cells may also pass into lymph nodes where they become trapped and targets of immunity activity. There actually has been little research on the lymphatic system though this has been changing recently.

The lymph nodes are frequently targeted for removal on the treatment of cancer. Removal of lymph nodes has been an essential component of therapies aimed at curbing this potentially devastating disease. Frequently removal of lymph nodes or radiation therapy targeting the lymph nodes may lead to condition of congestion or reduced flow of lymph. The lymph will back up leading to swelling of the tissues. Eventually this will in itself lead to inflammation and scarring. This condition is referred to as lymphedema. Edema or tissue swelling due to fluid and salt retention is different from congestion of the lymph system. Lymphedema may be prevented by certain interventions and can be effectively controlled or treated particularly if therapy is started as early as possible. Therapies include exercises, massage and compression garments, best directed by specially trained and highly skilled therapists.

Recently there have been some promising surgical therapies directed at reversing lympedema. These surgeries have included connecting the lymph vessels and veins under a surgical microscope and lymph node transfers or transplants. The results are encouraging; however this procedure is still considered experimental and thus not covered by insurance. Employing good surgical principles is also highly effective to minimize the risk of lymphedema development.

Patients at risk for lymphedema should avoid weight gain. This has been validated as a contributing risk factor. Infection the extremity at risk is also a well-documented risk factor. Heavy lifting, blood draws from or IV placement in the extremity at risk, air travel, or blood pressure cuff placement  have been incriminated as potential causative activities but evidence is lacking to support these restrictions.

The surgeons at Premiere Surgical Specialists uniquely offer screening for patients at risk for lympedema using the L-Dex system. This device measures the volume of the extremity at risk using electrical impedance technology. Patients in the screening program who are found to develop detectable volume changes prior to clinically symptomatic or visible lymphedema may enter into early lymphedema therapy. This intervention has been validated to prevent progression to clinical lympedema. We have had many patients who were kept free of this vexing problem through this effective screening and prevention program. We offer this screening program to all patients in our community even those undergoing surgery from our colleagues.  The L-Dex system is far more sensitive than other methods of volume assessment of extremities at risk.

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