Lymphedema is a chronic condition caused by a compromised lymphatic system that results in abnormal swelling of the extremities. Most often lymphedema is a result of surgery or treatment for breast, prostate, gynecological cancers or melanoma, but people can also be born with it. Lymphedema is not a rare disease, yet many people with this incurable condition either go untreated or receive ineffective treatment. To help counter the lack of awareness, we at Medicircle are conducting a lymphedema awareness series featuring eminent vascular surgeons, physiotherapists, and plastic surgeons, treating lymphedema to help raise awareness for people to help find knowledge and innovations that support them to be able to live their best lives with lymphedema.

Dr. Amish Mhatre is a consultant in vascular and endovascular surgery. He has an experience over 20 years in medical history. In his career spanning over two decades, he has performed 8000 vascular access surgeries. Dr. Amish is associated with various eminent healthcare organizations like Fortis Hospital, Hiranandani Hospital, Bhakti Vedanta Hospital, PD Hinduja Hospital, and Hinduja healthcare in Mumbai.

All about Lymphedema

Dr. Amish explains, “lymphedema is the accumulation of fluid because of obstruction of the lymphatic vessels.  Lymphatic vessels are the network of vessels in the body and like arteries and veins which carry blood, lymphatic carry lymph fluids. This lymph fluid consists of various molecules, mostly proteins and white blood cells, which help in fighting infections. Any obstruction in this pathway will cause accumulation of lymph’s in the affected part resulting in swelling. This swelling is commonly called lymphedema.”

What causes lymphedema

Dr. Amish talks, “Primary lymphedema is mostly congenital or hereditary lymphedema. This condition is very rare. These are seen in very young age groups, but we can find them in new-borns also. As these are very rare conditions, we don't often see them. The most common lymphedema is the secondary ones in which there is a swelling in the affected part. This can be secondary to injury, or commonly which we see in cancer surgeries, most of breast cancers. Infection like filariasis commonly called elephantiasis can also be a reason. But because of the improved hygiene in the society, we don't see elephantiasis very commonly nowadays.”

Dr. Amish adds, “Another cause for lymphedema is varicose veins. Delay in the treatment of varicose veins, resulting in swelling of the affected lymph, and eventually because of the high pressure in the veins and swelling in the legs, these lymphatic vessels can get damaged and they can have secondary lymphedema because of various problems.”

No specific treatment available

Dr. Amish suggests, “Except for preventing infections, injuries and treatment of varicose veins there is no specific treatment for lymphedema. For example in cancer surgery like breast or malignancy of the breast, most of the time the surgeon has to remove the lymph nodes, lymph vessels goes and drains into the lymph nodes. So, if we remove these lymph nodes, they will cause obstruction and accumulation of lymphatics in the affected limb. This is mostly seen in the upper limbs and in pelvic surgeries, the lower limbs can get affected.”

The primary approach for treatment

Dr. Amish speaks, “lymphedema is a chronic condition because it is a long-standing disease. Sometimes the patient requires treatment lifelong because there is no specific cure for this. The primary approach for this treatment should always be medical. This includes physiotherapy like manual lymphatic drainage, exercise, and fitting with non-elastic wraps and compression garments. These compression garments will prevent the accumulation of lymphatics into the tissues and swelling. Skincare is of utmost importance. Before applying moisturizer, wash your skin to prevent infection. This is important as because of that lymph, there is always chances of secondary infection. So, skincare is one of the most important things which one has to follow.” 

Dr. Amish emphasizes, “Apart from that, there is something called Intermittent Pneumatic Compressions. There is a device called the Lympha press which gives great compression to the legs and thus helping the lymph going back into the system. Depending upon the affected part, non-elastic compression garments are needed. So, for lymphedema, compression of non-elastic is needed.”

Primary treatment should be Medical management

Dr. Amish tells, “Lymphedema requires lifelong treatment because we cannot cure. Once the lymph nodes are removed, we cannot put a new lymph node. Medical management physiotherapy should be the primary treatment. If the patient is not benefitted from medical management, then we can offer surgery to him. Surgeries are a little difficult to perform in the sense because there is already a lot of fluid in the affected lymph’s and operating these becomes difficult with a risk of infection. So, we try to avoid surgeries."

Dr Amish says, “Those who have painful swelling where medical management is not helpful, we do a procedure. We remove the affected lymph tissues and then a skin graft is done on the affected lymph. Microsurgery is performed by identifying lymph vessels and attaching lymphatic vessels to the veins. A vein is a blood vessel that carries impure blood back to the heart. So, when we attached to domains, ultimately all the lymphatic channels connect and drain into the veins near the heart."

Dr. Amish adds, "there is one more technique which is called Omentum. Omentum is the policeman of the abdomen which prevents infection and helps in drainage of the abdominal fluid. This omentum is implanted or pushed into the affected area and it drains the lymph’s back into the system.”

(Edited by - Renu Gupta)