Most of the limb moisture has been collected by veins. It is said that the ratio is around 90%. The remaining , about 10% that can not be collected can be collected in lymph vessels. Most of the lymphatic fluid in the lymph duct consists of this 10% liquid that can not be recovered in this vein. The lymph duct flows to the lymph node, the lymph duct flows out of the lymph node again, and mostly eventually connects to the vein near the collarbone.

If this lymphatic vessel is impaired or function is deteriorated, it may result in lymphedema. Lymphedema is a disease in which lymph is swollen on limbs and faces. Although it is most likely that lymph nodes are removed because of cancer treatment or those who received radiation therapy, they may develop by unexplained cause. Sometimes they are caused by inborn factors, age ranges widely from children to elderly. They also occur in various places such as limbs and pubic areas. When progressing to a certain extent, it is clear by swelling and the left and right difference of the thickness of the limbs, but at first it is mostly only the subjective symptoms of pain and tenderness. If it is untreated, swelling progresses not only changes of the appearance but also increases the risk of functional disorders such as gait disturbance and the occurrence of infectious diseases and malignant tumors.

Conservative therapy

Conservative prophylactic treatment with compression by elastic stocking and skin care is the basis of treatment for lymphedema.
As lymphedema rapidly progresses due to the onset of infectious diseases (cellulitis), prevention and early treatment of infectious diseases are important. Combined physical therapy including lymphatic massage and other conservative therapies are considered effective, but it is a disadvantage that long-term treatment over a long period of time every day. However, it is indispensable therapy for lymphedema treatment. Professional therapists also do this in our center under the guidance of a doctor.

Surgical therapy

In our center, three surgical methods are used properly depending on the state of lymphedema. It is highly effective by combination of methods and multiple times.

1.LVA

Our first choice for surgical treatment is LVA.
Supermicrosurgery technique has made it possible to connect fine blood vessels that use to be impossible. What is more less invasion is the feature of LVA.  LVA is performed under local anesthesia through a few cm skin incision based on the preoperative findings through PDE.  There is a tendency as the number of LVA anastomosis increases, the effect become higher, so several surgeons perform LVA simultaneously in various places at the same time. We perform as much anastomosis as possible within about 4 hours of operation. Patients’ consciousness is clear during surgery because of local anesthesia. You can see the image of the operation and the surgeon performs surgery while explaining the situation of surgery. Hospitalization is about 1 - 2 weeks, and compression therapy by elastic stocking is required before and after surgery.

2.Lymph vessel transplantation

In case of lymphedema progresses, lymph venous anastomosis alone may not provide sufficient effect or lymphatic vessels that can be anastomosed may disappear.
In such a case, normal lymphatic vessels with subcutaneous adipose tissue are harvested and transplanted to lymphedema region. We often take the lymph vessel from the region between  axillar and the side chest, sometimes from the dorsal foot or inguinal region. It is usually performed under general anesthesia but we are currently developing a method with local anesthesia.

3.adipose tissue removal

In lymphedema, it is very rare that only lymph is the cause of the thickness, mostly also excessive proliferation of adipose tissue occurs simultaneously. The cause has not yet been fully elucidated.
In such a case merely improving the flow of the lymph is insufficient to improve the thickness. and it is necessary to surgically remove and reduce adipose tissue. We are doing adipose tissue reduction in various ways according to the part, the status, patient's wishes.

Diagnosis

Lymphedema can be almost diagnosed from the patient's story, the contents of the letter of introduction, inspection, palpation, etc. However, we will conduct the following texamnation to judge the progress condition.

ICG lymphangiography

We can observe the path of lymph duct and its condition through a special camera. Usually, an injection is given the day before surgery by injecting pigment called indocyanine green (ICG) under the skin. And it gives us the information by which we can decide where to perform LVA.