Lymphatic System and Lymphatic Surgery

Your body has a parallel set of plumbing to the arteries and veins collectively called the lymphatics. The lymphatic system captures fluid from your tissues and pipes it back to your circulatory system. Along the way, the lymphatics pipe through lymph nodes which act as security waystations for your immune system which monitors the fluid in the lymphatics for harmful agents such as bacteria.

Cancer cells can also travel through the lymphatic system and lodge in the lymph nodes. This is why your cancer surgeon may sample lymph nodes to check for spread of cancer.

General surgery, cancer surgery and removal of lymph nodes can cause damage to the plumbing of the lymphatic system, resulting in accumulation of fluid in the tissues or lymphedema.

There are now surgical procedures to address lymphedema.

Your surgeon may perform a lymphaticovenous bypass to directly link a lymphatic vessel to an adjacent vein, thereby bypassing or avoiding any lymphatic blockages that may develop as a consequence of surgery and allowing drainage of fluid to proceed through the lymphatic system. In some cases, this bypass procedure may be performed at the time of cancer surgery, as in prophylactic lymphaticovenous bypass, to reduce the risk of developing lymphedema.

In longstanding or more severe cases of lymphedema, it may be necessary to transplant healthy lymph nodes along with their associated lymphatic channels to the area of limb affected by lymphedema. This specialized procedure is known as vascularized lymph node transfer.

These procedures require specialized training in microsurgery. Dr. Otake will tailor these procedures in conjunction with the oncologic surgeon on an individual, patient specific basis to achieve the best outcomes.

Credit: Pyramid Klinic, Switzerland
Figure: Lymphaticovenous Bypass and Vascularized Lymph Node Transfer

Left Panel: Lymphaticovenous Bypass for Treatment of Right Arm Lymphedema
Blocked lymphatic vessel (green), resulting in lymphedema, and vein (blue) are accessed via small skin incisions in the forearm. The lymphatic vessel is cut and connected to the vein to complete the bypass.

Right Panel: Vascularized lymph node transfer for Treatment of Left Arm Lymphedema
Lymph nodes and associated artery (red) and vein (blue) are harvested from the groin and transferred to the armpit where lymph nodes were removed as part of the original breast cancer surgery. The restoration of lymph nodes and lymphatic channels helps to improve lymphedema.

Dr. Otake is active in sharing his expertise with organizations dedicated to the application and delivery of plastic surgery care to patients around the world.

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