lymphedema

Question 1

primary vs secondary

Answer 1

primary: congenital, milroys
;lymphedema praecox puberty, lymphedema tarta >35

secondary 2/2 iatrogenic, infection, irradiation, invasive tumor, inflammation

W.bacnfroti is MCC worldwide vs cancer here in US

Question 2

pathophysiology of lymphedema

Answer 2

goes into subnormal plexus, ready too interstitial edema and swelling….this chronic inflammation leads to scarring

Question 3

diagnosis

Answer 3

lymphocintigrophy van use indocyanine green

Question 4

Types and management

Answer 4

stage 0 - subjective feeling of heaviness
1 - mild lymphedema with pitting that is reversible with elevation
2 - non pitting, moderate, spongy, doesn’tt get reversed with elevation, positive sterner sign (toes and pinch, can’t do so)

FOR ABOVE TWO YOU CAN DO LVA, stage 2 can do VLNT

3-extensive fibrosis with skin changes, irreversible, recurrent infections (do lip and Vascularized lymph node transfer

4 - severe, bumps and protrusions

STAGE3 can do VLNT or lipo and some excision

non surgical management is complex decongestion therapy, manual massage and compressive devices, take care of nails to avoid infection

also have charles procedure

Question 5

LVA

Answer 5

find lymphatics and connect to vein to bypass a blockage seen on ICG or lymphocintigrophy

post op do compression devises, ASA, reflex, light activities…..has good data to reduce size up to 40% of time, but recurrent infections go down a lot

Question 6

VLNT

Answer 6

good candidates are those with competent veins, pitting edema and recurrent infections

donor sites include groin, submittal, supra scapular, lateral thoracic, momentum, etc

post care also do elevation and compression, asa, reflex, therapy

better reduction rates up to 80% with some donor site morbidity and resultant edema

9-12 mo reduction of volume seen