What is lymphatic system?
Lymphatic system belongs to the circulatory systems in our body and is part of the immune system. It can be found within the body similar to the arterial/venous system. Approximately 90% of the blood and nutrient pumped out by the arterial system to our body is recycled by the venous system. Lymphatic system is responsible for recycling the rest of the 10% to maintain fluid balance within our body. The transparent liquid within the lymphatic system is called lymph. Lymph may contain albumin, waste, bacteria, viruses, toxins, and other macro-molecules which cannot be transported via blood. The lymphatic system is also responsible for producing immune cells and antibody our body needs to fight against pathogens and diseases.
What is lymphedema?
Lymphedema can occur anywhere within our body, but it is most commonly found in the upper/lower limbs. The lymphatic system can be damaged or destroyed by lymph node dissection or irradiation. The obstruction of lymphatic flow at the proximal site can cause abnormal accumulation of lymphatic fluid in the limbs, leading to swollen limbs which is prone is cellulitis and difficult wound healing.
What are the causes of primary lymphedema?
It is due to poor development (aplasia or hypoplasia) of the lymphatic system. It is classified into 3 groups depending on the age of onset.
What are the causes of secondary lymphedema?
It is mostly caused by cancer excision, lymph node dissection, and post-operative adjuvant radiotherapy, resulting in lymphatic flow obstruction in the proximal end. Other factors include soft tissue infection, parasitic infection, malignancy, venous insufficiency, trauma, and obesity.
What are the possibilities of developing lymphedema after cancer treatment?
Unfortunately, about 20% and 30-40% of patients suffering from breast and gynecologic cancer will eventually develop lymphedema, respectively.
What are the symptom/signs of lymphedema
The is no obvious s/s for lymphedema patients other than slight tightness to the affected limb at the beginning. As lymphedema becomes severe, patient will feel: 1. Enlarged limb with heaviness; 2. Dry, thickened skin with more tense feeling; 3. Range of motion decreases in the joint area with decreased activity level; 4. Deterioration in skin integrity; 5. Poor wound healing; 6. Vicious cycle with recurrent cellulitis.
How is lymphedema staged?
Four stages base in clinical manifestation.
  • Stage 0: Subclinical lymphedema. No obvious change in appearance. It can be diagnosed with lymphoscintigraphy or ICG lymphography.
  • Stage I (mild lymphedema): Mimicking pitting edema. Lymphedema can be improved with limb elevation.  
  • Stage 2 (mild lymphedema): Hardened and tense skin. Soft tissue fibrosis. Heavy, tender, and discomfort limbs. The s/s cannot be relieved with simple elevation.
  • Stage 3 (severe lymphedema): Large and distorted limbs with hardened and thickened skin. Irreversible changes. Lymph leakage from skin with recurrent cellulitis is sometime evident.
How to treat lymphedema?
Minimal invasive procedures such as supermicrosurgical LVA can effectively reduce lymphedema.
The timing to receive supermicrosurgery?
ASAP once lymphedema is diagnosed. LVA is effective in reducing lymphedema and other co-morbidities such as cellulitis.