Vein Health &
Lymphodema / Lipoedema
Lymphoedema refers to gross swelling of a limb from poorly draining lymphatics. This may be from a genetic cause or secondary to surgery where lymph vessels are destroyed. This is typically post breast cancer surgery when lymph nodes from the armpit are removed or when groin lymph nodes are removed. Along with veins, we also get the lymphatic system.
A fundamental part of the cardiovascular system consists of lymph vessels and lymph organs that protect the body against harmful bacteria and transport fluid from the body tissues back to the cardiovascular system.
Lymph vessels are thin walled capillaries which absorb fluids, bacteria and protein, and propel them to lymph nodes, small lymph organs that filter and process the lymph by eliminating waste and bacteria. Lymph vessels and lymph nodes work together with larger lymph structures to maintain a normal healthy fluid balance.
Lipedema is when fat is distributed in an irregular way beneath your skin, usually in the buttocks and legs. Although it begins as a cosmetic concern, it can eventually cause pain and other problems. Lipoedema can be mistaken for regular obesity or lymphoedema. Lipoedema may affect up to 11% of women.
Patients are often misdiagnosed as fat. Lipoedemia is genetic and runs in families and there is a specific distribution – waists size is often small or normal and weight is gained on the thighs or upper arms. When weight is lost it is around the waist. Patients have tender legs and arms and find they bruise easily.
It is important in both lymphoedema and lipoedema to ensure there is no underlying vein problem as this can contribute to limb swelling and is treatable. Thereafter both conditions are managed by lymph drainage and lifestyle changes. Patients are eligible for the OptiVein programme and other nutritional advice that may help both conditions. A surgical option is liposuction. This has to be planned by the team and there are certain techniques for the different conditions. Dr Redman has visited overseas units in order to learn these techniques.
Lymph drainage can be done by a machine or by a trained lymphoedema therapist.
At Optivein we utilise our unique lymphatic pump machine which are compression pumps which force air in sleeves with multiple chambers which house overlapping cells. The pump forces air into the cells which encourage lymph fluid to continue moving and not pool. Lymphedema pumps are not just a reactive treatment but in many cases, they aid in softening fibrotic tissues which will create an environment for higher efficiency lymphatic drainage.
The same pumps may be used on our lipidoedema patients for improved appearance.
Should you see a therapist we will direct you to a properly trained therapist. The term lymph massage or lymph drainage is vague and to get optimal results, you should be seen by a properly trained therapist. These therapists are physiotherapists, occupational therapist or nurses who have specialised in lymphoedema and done dedicated training.
If needed, we have a lymphedema therapist available to tend to your condition after the procedure. They usually will assist in lymphatic drainage massage. A technique which stimulates the lymphatic system to function optimally by facilitating enhanced removal of waste products and toxins. It does this by increasing the rate of contraction of lymphangion’s which are little pumps within the smooth muscle wall of lymph vessels, drawing lymph more effectively towards lymph nodes and onwards. This gentle massage technique is done in a rhythmical, systematic way, starting centrally in the neck area, and working towards the peripheries. It includes deep abdominal breathing which further enhances the drawing of waste products towards the thoracic duct and terminus where most lymph fluid enters the bloodstream.
Lymphoedema may be advanced and although drainage is always necessary to move lymph fluid, if it has been there for many years, adipose tissue has built up.
Currently, there is no way of removing this effectively. Microsurgical techniques, such as lymph node transfers and lympho-venous anastomosis are done by some plastic surgeons, Although this will help lymph drainage, it does not decrease limb volume.
Dr Hakan Brorson in Sweden, is internationally renowned for a specialised technique of liposuction specifically for lymphoedema patients with excellent outcomes. Dr Redman has attended this and is bringing it into South Africa.
This will be a treatment for compliant lymphoedema patients as use of compression garments and lymph drainage will need to be continued strictly thereafter.
Lipoedema patients may also benefit from liposuction and different techniques are done in different units to treat eligible patients.
Dr Redman is learning these management techniques from Dr Schingale's clinic in Germany.