Microsurgical treatment of hand lymphostasis
During the surgical treatment of breast cancer, in addition to the removal of the tumor, the surgeon is required to verify the presence of metastases in the auxiliary lymph nodes.
During an operation at Clinic Helena we carry out a choice of ”sentinel” lymph nodes and an investigation for the presence of metastases. If during the first lymph flow from a breast tumor there are not auxiliary lymph node metastases, then the removal of the other enlarged lymph nodes is not required. Upon detection of metastasis a surgeon removes a group of lymph nodes, which are further explored in the histology laboratory.
Complications after removal of auxiliary lymph nodes
Removal of auxiliary lymph nodes may cause post-operative complications called a hands lymphostasis. Therefore, during the operation everything possible is done to remove all the lymph nodes with metastases, providing maximum radical cure of cancer, but at the same time, we keep all the healthy lymph nodes in the armpit. The removal of lymph nodes affects the integrity of a lymphatic channel in this area and can subsequently cause difficulties to lymph drainage.
Postoperatively, some patients complain of swelling of the hands if they were operated for breast cancer. In addition, a violation of lymphodynamics can be caused by radiation therapy, and related sclerotic changes in the lymph nodes. Due to a violation of lymphatic drainage, persistent and prolonged swelling may eventually appear. Chronic lymphatic stasis and tissue fluid in hands lead to an increase in the volume of the limb, growth of interstitial and intravascular pressure. This causes pain, limited movement, creating conditions for the development of trophic and infectious processes.
Methods of hand lymphostasis treatment
To cure lymphostasis there is a complex conservative treatment which usually includes physiotherapy treatments (massage, LPG), gymnastics in the pool, compression therapy and other methods.
For those cases where conservative measures do not bring sufficient results, Dr. Helena Puonti has developed a comprehensive methodology for effective surgical treatment lymphostasis. At the stage of the so-called solid lymphostasis, fluid accumulates in the subcutaneous fat, making noticeably thicker hand tissue and the hand becomes tight and tense.
If the main depot which collects a lymph in fat hands tissue is removed, the congestion is reduced. In these cases, Dr. Helena Puonti uses a delicate process for the removal of the fat on the arm by water-jet liposuction. During this procedure, fat cells are gently washed away, and thus, soft hand tissue reduces the potential for fluid retention. After this manipulation it is necessary to continue to wear a compression bandage, but the severity of debilitating swelling decreases markedly.
Microsurgical treatment methods of lymphostasis
Another very effective way to treat lymphostasis, requiring advanced microsurgical techniques, is to restore the lymphatic drainage. After removal of the auxiliary lymph nodes, the integrity of the lymphatic channel is violated which prevents normal lymph circulation in the limbs.
Therefore, the surgical treatment of this kind of lymphostasis is the most effective solution. In such cases Dr. Helena Puonti performs additional anastomosis (microanastomosis) between the vessels at the elbow and shoulder, which improves circulation and tissue fluid drains swelling.
In some cases, Dr. Helena Puonti employs an almost unique microsurgical intervention, performing a transplant from a healthy lymph node area. After surgery the swelling disappears or greatly reduces, and the patient is able to return to normal life.