- Question from Nicole: Can having a prior injury, say, to the shoulder or elbow, make moving the lymph fluid more difficult around this area?
- Answers - Sara Cohen, OTR/L, CLT-LANA Sometimes having a scar can prevent lymph fluid from flowing efficiently, particularly if it's a thicker scar.
In an existing lymphedema, we only will perform a surgical procedure if really necessary. Again, traumatizing the lymphatics in a lymphedema-affected limb could potentially worsen the condition. Today people do go through carpal tunnel syndrome surgery, which is quite common. I recommend that my patients do some more aggressive MLD and bandaging before the surgical procedure. Also, make sure to go on antibiotics 24 hours before the surgical procedure to avoid an infection. With these precautions, most of my patients really had no problems.
Breast reconstruction is another issue. Women who have reconstruction may already have existing lymphedema, and if they go through an additional surgical procedure, the edema might worsen. Then again, many patients do fine. It's very individual, and women should discuss the issue carefully with the plastic surgeon. A person who doesn't have lymphedema but has a prior trauma to the limb may already have a compromised lymphatic system that could lead into earlier lymphedema. But again, it's very individual.
I really encourage doctors to refer their patients before the surgery to a physical therapist or other lymphedema specialist, to spend an hour with them and educate them about what to do after surgery to lower the risk for lymphedema. Sometimes patients can do prophylactic manual lymphatic drainage as a preventive method, and there are patients who do not have lymphedema today but still do the drainage daily. It takes 10 minutes, not a big deal, and people should be aware of this option.
- Marisa Weiss, M.D. Somewhat related, this is an opportunity to comment on one approach to the treatment of lymphedema that's suggested by few people, and that is surgery to relieve the condition. I have seen only disasters when a surgeon attempts to use surgery to improve the flow of fluid off the arm. In my strong opinion, this procedure is contraindicated.
- Saskia Thiadens There are surgeons in Italy who have done a fair amount of lympho-venous anastomosis (connecting lymph vessels to veins). Some patients had successful outcomes, but it is extremely important to monitor these patients very closely. It is not done in the U.S. There is a surgeon in Malmo, Sweden, who has done liposuction in upper extremity lymphedema, and states that he has 100% reduction. The key to the reduction is that these patients wear a compressive sleeve 24 hours around the clock. A lymphedema nurse therapist in Colorado recently took a patient to Malmo, participated in the surgery, spent time with the surgeon, and brought the patient home with 100% reduction with wearing the garment.
On Wednesday, July 17, 2002, our Ask-the-Expert Online Conference was called Arm Lymphedema Prevention and Management. Sara Cohen, O.T.R./L., C.L.T.-L.A.N.A., Saska Thiadens, R.N. and Marisa Weiss, M.D. answered your questions about preventing and managing arm lymphedema.
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