Mayo Clinic: What do you recommend for someone who has
lymphedema in the leg that doesnít respond to wraps or
compression? At what point is surgery to reduce the swelling a
mainstay of treatment for lymphedema is conservative therapy
that doesnít involve surgery. Lymphedema treatment usually
starts with wraps and compression. If that doesnít work,
other nonsurgical options are available. If thereís no
improvement after thorough use of conservative treatment, then
it may be necessary to consider surgery.
affects your lymphatic system, part of your bodyís immune
system. Your lymphatic system circulates lymph fluid
throughout your body, collecting bacteria, viruses and waste
products. It carries this fluid and these substances through
your lymph vessels and into the lymph nodes. The wastes then
are filtered out by infection-fighting cells in the lymph
happens when your lymph vessels cannot adequately drain lymph
fluid. That usually happens because of damage to or removal of
lymph nodes from an infection, trauma, cancer treatment or
surgery. When lymph fluid doesnít drain normally, the excess
fluid builds up and causes swelling, most often in an arm or
leg. If itís not promptly and properly treated, the
accumulation of lymph fluid eventually can lead to solid
deposits of fat and fiber in the areas affected by lymphedema.
That can make the condition more difficult to treat
effectively and therefore more likely to require surgery.
therapy usually is the first line of treatment for lymphedema.
It involves wrapping the entire arm or leg in a snug bandage
or compression garment to reduce swelling and encourage the
flow of lymph fluid.
wrapping alone isnít enough, an approach called complete
decongestive therapy may be useful. That approach includes
wrapping and other techniques, such as massage, exercise and
skin care, to ease swelling. Your doctor also may recommend a
device that puts pressure on your limb to move lymph fluid.
These compression devices usually consist of a sleeve worn
over the arm or leg connected to a pump that intermittently
inflates to provide pressure.
donít see improvement with decongestive therapy, then
surgery would likely be the next step in treatment. Some of
the surgical techniques used for lymphedema must be performed
when the condition is still in the fluid phase, before solids
are deposited in the affected area. A delay in treatment that
allows solids to accumulate may require more complex surgical
approaches and can make lymphedema more difficult to treat
surgical techniques that can be used to treat lymphedema while
itís still in the fluid stage are vascularized lymph node
transfer, lymphaticovenous anastomosis and lymphaticolymphatic
first, vascularized lymph node transfer, releases scar tissue
thatís blocking the lymph fluid. It also transfers a soft
tissue flap from a donor into the affected area. This flap
contains lymph system components. The second surgical
technique, lymphaticovenous anastomosis, connects existing
lymphatic vessels to tiny veins located nearby, allowing the
extra lymph fluid to drain directly into the veins. The third
approach, lymphaticolymphatic bypass, connects normal
functioning lymphatic vessels from a donor directly to the
lymphatic vessels of the affected limb.
lymphedema progresses to the point that solids start to
accumulate in the limb, other surgical procedures must be used
to remove that material. Those techniques donít address the
underlying cause of lymphedema, though, so you still need
compression or other therapy after that surgery. In some
cases, surgery to remove the solids can be combined with one
of the other surgical techniques mentioned earlier to resolve
right surgical procedure for lymphedema varies depending on
your individual situation. With proper diagnosis and
evaluation, however, surgical techniques can be used to treat
lymphedema safely and effectively in many people when combined
with integrated lymphedema therapy.