What is Lymphedema?
Lymphedema is the abnormal accumulation of lymph fluid in the tissues. Lymphedema could either be Primary or Secondary. Primary lymphedema is caused by a malformation of the lymph vessel network or lymph nodes and can be evident at birth or appear later in life. Secondary Lymphedema (most common type) results from trauma, surgery, cancer, infection and radiotherapy etc., that caused damage to the various components of the lymphatic system.
Damaged lymph vessels or nodes are unable to drain lymph fluid from the tissue, which leads to lymph fluid accumulation, swelling, chronic pain, inflammation and heaviness in the affected area. Lymphedema management starts with a lymphedema therapist and includes exercise, manual lymphatic drainage massage, various degrees of graded compression garments/bandages and pneumatic compression. This is followed by various surgical options depending on the stage of lymphedema and are divided into physiological, debulking and combined options. Physiological options address the “lymph fluid” buildup and allow for continued drainage of the affected limb.
Debulking procedures address the “fat and fibrous tissue” that develops due to the chronic inflammation from the lymph fluid in the tissues. As lymphedema progresses, these procedures need to be combined to get the best outcome. Indocyanine green (ICG) lymphangiography imaging is used to stage lymphedema, map out the functional lymph vessels and monitor progress after surgery. Dr Moodie has partnered with Erika van der Mescht and the team at Physio-Kinetix to provide comprehensive lymphedema therapy before and after surgery.
LYMPHEDEMA AND LIPEDEMA SURGERY
PROCEDURES FOR LYMPHEDEMA SURGERY
Physiological options:
Debulking options:
(Flying squirrel technique) :
This procedure addresses the "fat and fibrous tissue" component of lymphedema in the affected limb. The first step is aggressive liposuction to remove as much fat as possible circumferentially. In most cases, this leaves the limb with a significant amount of excess flabby skin. The second step is surgical excision of the internal thick fibrous tissue. The third step is excision of the excess flabby skin and precise closure to contour the limb as required. Lymphedema liposuction is only a debulking procedure and does not add any physiological lymph drainage mechanism. It should therefore be followed by a lymph node transfer 6-9 months after the liposuction procedure.
FAQ
What is lipedema?
Lipoedema is a chronic condition resulting in abnormal and often painful accumulation of subcutaneous fat and connective tissue in particular body regions, such as the legs, thighs, buttocks and sometimes. It predominantly affects women and is often misdiagnosed as obesity. Lipedema is a condition where fat is distributed in a disproportionate way.
Typical symptoms of lipoedema include the following:
- Disproportionate fat distribution
- A heavy sensation in the legs
- Mild discomfort to severe pain.
- Chronic fatigue, which results in feeling more tired than normal.
- Skin that easily bruises.
What are some of the causes of lipedema?
The exact reason for lipedema remains unknown but is believed to be linked to hormonal changes, particularly during puberty, pregnancy, menopause and it often has a genetic component.
How do you check for lipoedema?
The diagnosis is primarily made on clinically. In certain situations, a venous Doppler ultrasound and ICG lymphography may be required to rule out venous and lymphatic disease.
Stages of Lipedema
Lipedema is classified into stages based on the severity of tissue change:
- Stage 1: Smooth skin surface with enlarged, pearl-sized nodules in the fatty tissue.
- Stage 2: Uneven skin surface with larger, pearl-sized to bigger masses and fibrous tissue.
- Stage 3: Large, loose lobules of fat and skin that can cause functional issues, sometimes leading to mobility problems.
- Stage 4: Development of Lipolymphedema, where the lymphatic system becomes compromised, often in later stages.
How do you treat Lipedema
There is no cure for lipedema, but symptoms can be managed to slow progression.
- Compression Therapy: Some patients benefit from the use of compression garments or bandages to reduce pain and swelling.
- Liposuction +/- limb plasty: Specialised liposuction can remove the abnormal fat, followed by excision of excess skin provide long-term relief.
- Conservative Management: Some patients benefit from manual lymphatic drainage (massage), low-impact exercise (e.g., swimming), and skin care.
- Diet: An anti-inflammatory diet is often recommended, though traditional calorie-deficit diets do not remove the lipedema fat.
DON'T ONLY PRACTISE YOUR ART BUT FORCE YOUR WAY INTO ITS SECRETS; ART DESERVES THAT.
Beethoven, 1812
DR MOODIE
Dr Moodie knew that he wanted to become a surgeon from the onset of his medical school training at the University of Pretoria, finding the opportunity to repair the human body extraordinary.
His logo, which you see on this website, was inspired by a sculpture by Reghardt van der Meulen “Fragmented“.