Post-surgical lymphedema

What is post-surgical edema

Post-surgical edema is due to unintentional damage to various anatomical structures during curative surgery that addresses especially tumour pathologies.

What are the factors that lead to the disease?

The evolution in medicine has allowed the discovery and successful use of minimally invasive surgical techniques, but there are situations in which an extensive approach to tumour formations with total or subtotal removal of lymph nodes in the vicinity of the affected organ is needed to prevent secondary metastases, due to the spread of cancer cells.

Lymphatic edema is due to the sectioning of large caliber collecting vessels of the lymphatic system in surgical treatments to remove the affected lymph nodes and primary tumor, disrupting the distribution and flow of lymph in the area where the intervention is performed.

How the condition manifests itself

Depending on the location of the tumour and the affected lymph nodes, edema may occur in the upper limbs (breast cancer with total or subtotal axillary lymph nodes), in the case of lower limbs (gynaecological tumors, bladder tumours, prostate, testicular or penile) but also at the level of the cephalic extremity of the body. The accumulation of lymph in the soft tissues may be accompanied by a feeling of heaviness, pain, functional impotence of the affected limb and its joints (secondary to the traction given by the increase in the volume of the hand/foot).

Manifest clinical edema may occur within a few months or even years after surgery due to the body's high reserve functional capacity (the lymphatic circulatory system compensates for the imbalance of lymph distribution due to the numerous lymphatic capillaries).

How to treat edema after surgery

To prevent the onset of clinical oedema, there are some helpful tips:

• In the case of patients with surgically treated breast cancer, it is good to avoid wearing heavy bags on the affected side of the shoulder, bras with narrow straps that exert pressure due to the weight of the breast or prosthesis (if you opt for remodelling), avoid applying the sleeve of the tensiometer on that side, avoiding tight-fitting elastic cuffs clothes and fixed /hand-held jewellery;
• Avoid exposure to high temperatures (hot baths, sauna, improper working environment-bakery, steam presses, foundries), avoid waxing in the area with lymphedema;
• Maintaining an optimal body weight in balance with the  height;
• Avoid physical effort/exercise that overloads the affected limb (gym workouts, long-distance cycling) - we must opt ​​for moderate physical exercise without overloading the region prone to edema;
• During the night it is good to sleep with the legs slightly raised above the level of the torso to ease the lymphatic flow, and during the day we should avoid the sloping position of the lower limbs and the "foot over foot".

The actual treatment of post-surgical oedema benefits from lymphatic drainage performed by specialists when we have no contraindications (infections, thrombosis, skin allergies, tumour infiltration of lymphatic vessels), but also from lymph-taping methods and classic compressive bandage (phase or compression stockings). The surgical approach is done with the help of high-performance techniques that make possible to perform lymphovenous anastomosis and lymph node transplantation.