Post-Surgery Lymphedema: Common Concerns and Solutions

Several issues related to recurrent swelling after lymphatic-venous anastomosis surgery?

1: As mentioned, it has been 3-4 weeks since the surgery, and the wound has healed.
The previous slight tingling sensation has almost disappeared! I have been wearing compression stockings and massaging the swollen areas as instructed by the doctor.
However, I have noticed that the swelling fluctuates; sometimes it reduces significantly (with a swelling height of about half a centimeter) for about a week, while at other times it swells back up to the level it was immediately after surgery (with a swelling height of about one centimeter), also for about a week.
Why does the swelling fluctuate like this? Is it related to temperature changes causing expansion and contraction, or is it related to the food I eat? Do I need to avoid certain foods?
2: I previously sustained an injury to my calf bone in a car accident, which may have indirectly affected the lymphatic vessels.
I thought the doctor would perform surgery directly on the injury site to repair the damaged lymphatic vessels.
However, the doctor only made an incision on the top of my foot to connect the lymphatic vessel to a vein.
Is it sufficient to only operate on one site (I have swelling below my left ankle, and in severe cases, the lower half of my calf also experiences some swelling)? Will the damaged lymphatic vessels continue to leak lymph fluid and cause swelling, or will they eventually stop on their own? An MRI was performed before the surgery; can an MRI detect damage to the lymphatic vessels in the calf?
3: Is it possible to completely heal and have no swelling at all? Or will there always be some residual swelling? On average, how long does it take? I apologize for the many questions; these are just what I could think of for now! Thank you.

Liang Xiansheng, 40~49 year old female. Ask Date: 2024/01/16

Dr. Zhou Hongzhang reply Plastic Surgery

These issues are quite specialized, so it's best to consult your physician in the outpatient clinic.

1.
The impact of temperature on thermal expansion and contraction is relatively unrelated; it is more associated with posture rather than the food consumed.
It is advisable to keep the affected limb elevated as much as possible.

2.
The swelling is likely caused by the previously damaged lymphatic vessels that continue to leak lymph fluid, making it difficult for the swelling to resolve on its own.
An MRI with contrast may help identify the areas of lymphatic damage in the calf.

3.
It is very challenging to achieve complete recovery.
Any improvement is already considered a positive outcome.

Reply Date: 2024/01/16

More Info

Understanding post-surgery lymphedema can be quite complex, especially after a significant surgical procedure. Lymphedema is a condition characterized by the accumulation of lymphatic fluid in the tissues, leading to swelling, most commonly in the arms or legs. It can occur after surgery, particularly if lymph nodes are removed or damaged, as in your case. Let's address your concerns systematically.

1. Fluctuating Swelling: It is not uncommon for lymphedema to fluctuate in severity. The swelling can vary due to several factors, including physical activity, temperature changes, and dietary choices. For instance, heat can cause blood vessels to dilate, leading to increased fluid accumulation, while cold can have the opposite effect. Additionally, high-sodium foods can contribute to fluid retention, exacerbating swelling. It's essential to maintain a balanced diet and stay hydrated, as well as to monitor your sodium intake. Compression garments, like the pressure socks you mentioned, are crucial in managing lymphedema, as they help to maintain pressure on the affected area and prevent fluid accumulation.

2. Surgical Approach and Lymphatic Damage: The surgical approach you described, where the lymphatic vessel was connected to a vein, is known as lymphovenous anastomosis. This technique can be effective in redirecting lymphatic fluid and reducing swelling. However, if there was significant damage to the lymphatic vessels due to your previous injury, it may take time for the lymphatic system to adapt and for the swelling to decrease. The fact that only one incision was made may suffice, but the effectiveness can vary based on the extent of the damage and individual healing processes. The lymphatic system is quite resilient, but it may take time for it to recover fully.
3. Long-term Management and Prognosis: Complete resolution of lymphedema is possible for some individuals, but many may experience some degree of swelling long-term. The prognosis can depend on various factors, including the severity of the initial injury, the extent of lymphatic damage, and how well you adhere to post-operative care, including wearing compression garments and engaging in prescribed exercises. Regular follow-ups with your healthcare provider are crucial to monitor your condition and adjust your treatment plan as necessary.
In terms of timeframes, recovery from lymphedema can vary widely. Some patients may see significant improvement within a few months, while others may take longer. Engaging in physical therapy focused on lymphedema management can be beneficial. Techniques such as manual lymphatic drainage, compression therapy, and specific exercises can help reduce swelling and improve lymphatic flow.

In conclusion, managing lymphedema post-surgery requires a multifaceted approach, including lifestyle modifications, adherence to compression therapy, and regular medical follow-ups. While some degree of swelling may persist, many patients can achieve significant improvement with appropriate care. If you have ongoing concerns or if the swelling worsens, it’s essential to consult with your healthcare provider for further evaluation and tailored management strategies.

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