Surgical
Procedures
Reconstructive Micro-surgery
Lymphedema
The treatment of acquired lymphedema has been sought after for
many years. The swelling of an extremity following ablative cancer
surgery and radiation is due to the destruction of the lymphatic
channels ability to transfer the protein rich fluid in the subcutaneous
space to the venous circulation.
Presently, the most common form of therapy is by massage and
compression with wraps or elastic garments. Lack of compliance
with these programs leads to an ever worsening state and places
the patient at the risk of infection of the static lymph, called
lymphangitis. These infections can be very serious, requiring
long-term antibiotics and frequent hospitalization.
Until just a few years ago, there were no alternatives to the
traditional treatment of lymphedema. Now a new very promising
treatment with has been developed.
Dr. Dabb has had a special interest in this problem for 25 years.
As a result he has developed a treatment protocol, which includes
a meticulous evaluation with lymphocintigraphy, ultrasound, digital
photography and response to physical therapy. Depending on the
results of these studies, a patient may be found to be a candidate
for lymphatico-venous anastamotic bypass surgery. Dr. Dabb is
one of the few surgeons in the United States offering this procedure.
Lymphatico-venous surgery involves identifying obstructed lymphatics
under the operating microscope. The may be located by using a
"sentinal node" like technique with a radioisotope and
visualized by injecting a blue dye. Once isolated, they are then
redirected and anastamosed to accompanying veins, allowing the
lymph to "bypass" the obstruction. If three or more
lymphatics are anastamosed, one may expect a reduction in limb
volume, improved sensation of the extremity, and a lower incidence
of lymphangitis, and loss of the compression garment during the
day.
Of the patients operated, independent assessment has revealed
improvement in 80% of the patients over physical therapy alone.
