Lymphedema and Lymphology

1
Lymphedema and Lymphology
Marlys H. Witte, MD, Professor Michael J Bernas,
MS, Associate Scientific Investigator UA College
of Medicine, Department of Surgery
2
Lymphology is the Study of Lymph, Lymphatics,
Lymph Nodes, andLymphocytes in Health and Disease
3
(No Transcript)
4
Lymphatic System is a Vasculature
5
and a Circulation
6
. . .and the Immune System
7
Lymphatic System consists of Truncal and
Extratruncal (including superficial dermal)
components continuous with tissue spaces
Courtesy Jobst
8
. . .and can be imaged in continuity
9
particularly by Lymphangio/Adenoscintgraphy.
WB LAS
Normal
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
which sets into motion a sequence of events
promoting lymphangiogenesis and further
lymphangiodysplasia...
15
Cellulitis and Lymphangiosarcoma
16
(No Transcript)
17
Current Treatment Modalities

• Physiotherapy

• Operations
• Pharmacotherapy

Trial Design Issues / Pitfalls Protocol
Standardization and Compliance
18
Combined Physiotherapy Origins
1892 - A. Winiwarter developed initial manual
massage
Die Elephantiasis, Stuttgart, Germany F. Enke
1892
1935 - E. Vodder developed Manual Lymphatic
Drainage

• Le drainage lymphatique, une nouvell methode.
  Sante Pour Tous. 1936
• Die manuelle lymphdrainage ad modum Vodder.
  Instruktionsheft mit Behandlungstaflen, 1970

1970s - M. F?ldi incorporates modified MLD with
bandaging
The Lymphedema Chaos A Lancet. Ann Plast Surg
1989(22)505-515
1989 CPT started as usual treatment in some U.S.
centers
Lymphedema reduction by non-invasive complex
lymphedema therapy. Prog Lymphol
1993601-603 Effective Treatment of Lymphedema of
the Extremities. Arch Surg 1998(133)452-458
19
LYMPHEDEMA TREATMENT CENTER
University of Arizona HealthSouth
Rehabilitation Institute of Tucson
20
Combined Physiotherapy Phase I--Acute Treatment
Manual Lymph Drainage
Skin Care
Exercise
Compression Bandaging
21
Combined Physiotherapy Phase II--Maintenance
Skin Care (Daily)
Manual Lymph Drainage (Night)
Compression Bandaging (Night)
Compression Garment (Day)
22
Outcomes of CPT
Before Treatment
After Acute Treatment ( gt50 reduction)
23
Surgical Approaches
1) Lymphatic-Venous Shunts
24
3) Liposuction Prof. H. Brorson Malmo, Sweden
Complete reduction of lymphoedema of the arm by
liposuction after breast cancer. Scand J Plast
Reconstr Hand Surg 31137, 1997 - first 28
patients reported with 106 reduction at 12
months Liposuction combined with controlled
compression therapy reduces arm lymphedema more
effectively than controlled compression therapy
alone. Plast Reconstru Surg 102 1058,
1998 -compared 14 pts with liposuction (104) to
14 without (47)
25
3 years post
1 year post
Brorson, Svensson, Norrgren and Thorsson.
Lymphology 31(Suppl) 570-575, 1998
26
Pharmacotherapy /Alternative Medicine
27

• Prevention?
• Sentinel node treatment
• Radioprotection
• Precautions
• early detection, identification and intervention

28
Future Therapy ?
Current
Combined Physiotherapy Debulking
Microsurgery Liposuction
Gene Therapy Lymphangiomodulators Stem
Cells/Cloning Tissue Engineering/ Artificial
Lymphatics