By: Mindy Bowen BSN, RN, CAPA, RN-BC Nurse Clinician
University of lowa Hospitals and Clinics Department of Plastic and Reconstructive Surgery

Lymphedema is a complicated medical condition that is poorly understood. Patients are often misdiagnosed, undergo unnecessary tests, and are managed incorrectly. Lymphedema is a common problem and a chronic condition that does not improve and slowly worsens. Lymphedema research is in its infancy, but we know enough to know we can help. Treatment for breast cancer can cause lymphedema. The disease can occur early, within the first few years, or later. lt is the direct injury to the lymphatic system that creates the risk. Radiation can also increase the risk. 56% of breast cancer survivors will develop lymphedema within two years.

Once lymphedema develops, early treatment and diagnosis is important. We have highly sophisticated diagnostics, for example: lndocyanine Green lymphography (lCG), which is very sensitive and very accurate. We also use a Biolmpedence measurement as well as limb measurements.

After a diagnosis has been confirmed, nonsurgical options and surgical interventions are discussed. Nonsurgical options would include, exercise, compression garment, massage, pneumatic compression. One of the surgical interventions that the University of lowa offers is the Lymphaticovenular anastomoses (LVA).

LVA is a treatment for lymphoedema that can improve lymph circulation by the connection of lymph vessels and veins. While the LVA is most effective in patients with early disease, it can still be offered selectively in those with more advanced disease. LVA is an advanced, minimally-invasive procedure. lt uses an ultra-high power microscope and a super-microsurgical technique.

The lymphatic vessels are in the range of 0.2-0.5 mm and are connected to nearby veins. The size of these vessels is similar in size to a human hair. This surgery by-passes the lymphatic obstruction and reconnects the lymphatics with nearby veins. This allows lymphatic fluid to bypass the obstruction and flow directly into the bloodstream reducing symptoms of lymphedema. This procedure takes approximately eight hours and involves a one night stay in the hospital. The incisions are about one inch long and only go superficially under the skin surface. This is where the lymphatics and veins will be found. There are usually 4-6 incision sites that we will use to perform the anastomosis.

We use an "Octopus" technique where we will use quite a few lymphatic vessels and anastomose them into a vein. So instead of just one lymphatic vessel to one vein we use numerous lymphatics into one vein. 
When the surgery is successful it works really fast. We know this by the results we see in the patients and by the testing that we perform preoperatively and postoperatively.

We use different measurements and staging systems. One staging system is the Campisi staging which measures where you are clinically with swelling. We also use the lndocyanine Green (lCG) Dermal backflow staging system for the lymphographic staging. Before and after measurements are recorded as well as a Bio-impedence reading.

The below photo is from a patient that had LVA surgery using the Octopus technique, notice the reduction in the staging and the difference in the measurements and size reduction in her right arm. She not only had a good reduction is the size of her arm, but both her Campisi and Lymphagraphic scores dropped and she had complete relief of her right arm pain. 
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For more information or if you would like to set up a consultation with Dr. Wei Chen please give our office a call at 319-384-8129.






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By Katie Boaldin, PT, DPT

​Lymphedema is the abnormal accumulation of lymphatic fluid in the tissues1 . It can occur when there has been trauma to the lymphatic system, such as surgery or radiation for cancer. Symptoms may occur immediately following surgery or may present a few months or even years later.

Lymphedema is a condition that can worsen without treatment. At this time there is no cure, however it can be managed successfully with collaboration between the patient and medical team (physician, therapist, and certified garment fitter). The earlier treatment begins, the more successful the management.

The goal of treating lymphedema is to decrease the swelling and keep it down1 . There are a variety of causes of lymphedema. As stated above, a common cause is surgery or radiation for cancer. This can result in lymph nodes being removed or damaged, which decreases the ability for that area of the body to transport fluid.

Other possible causes of lymphedema include: infection, injury (such as a burn causing scar tissue), venous insufficiency (veins unable to pump sufficient fluid back to the heart), and developmental abnormality1 . Signs and symptoms of lymphedema include: swelling in the affected area, skin tightness, a sensation of fullness, or tight clothing/jewelry (that was not previously tight).

It is important to contact your doctor if you feel you have symptoms of lymphedema so that the necessary treatment can be initiated. A person at-risk for developing lymphedema should be aware of certain precautions to decrease the likelihood of developing the condition:
• Avoid strenuous or repetitive activity/exercise.
• Avoid extreme heat or too much sun.
• Avoid injuries to the skin as this provides an area for bacteria to enter and increases the chance for infection.
For example, avoid injections and IVs in the affected arm, avoid bug bites, wear gloves when gardening, and use an electric razor to shave in the underarm area. • Avoid blood pressure tests in the affected arm.
• Avoid constrictive clothing.
• Practice good skin care techniques including keeping skin clean and moist (use fragrance-free alcohol-free lotion).
• Wear your compression garment while traveling, particularly long distances or on an airplane.

Remember, lymphedema is a very manageable condition in which early detection and treatment leads to the best outcomes.
The first step is education and awareness. If you think lymphedema is affecting you, please consult your physician.

Bibliography 1Zuther. JE. Lymphedema Management.
The Comprehensive Guide for Practitioners.
2nd ed. New York: Thieme, 2009


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