Lymphoedema is the pathologic accumulation of lymph fluid in the tissues. This results in swelling (edema) of the corresponding body area, leading to chronic inflammation and fibrosis. The human body has a complex network of lymphatic vessels and glands such as the network of arteries and veins. When the normal drainage of lymphatic system gets disturbed, a sequence of conditions happens which, if not addressed quickly and on time, may lead to irreversible damage. There are two types of lymphedema:

  • The Primary Lymphedema, which is caused due to hypoplasia, hyperplasia or aplasia of the lymphatic system and occurs mostly in the upper limbs, and
  • The Secondary Lymphedema, which is caused due to congestion of the lymph nodes and lymph vessels during malignancy, surgical removal of the lymph nodes such as malignant melanoma or breast malignancies, in cases of inflammation such as lymphadenopathy reactive type and in cases of fibrosis after irradiation of the corresponding body area.

Lymphedema

  • The impact of lymphoedema at the upper end depenads on the extent of surgery, the number of lymph nodes, radiotherapy, age and weight of the patient. So it appears from studies that have been conducted, that the secondary lymphedema of the arm is more common in obese women over 55 years old.

Lymphoedema is one of the most common complications after radical lymph node cleaning of the axillary region in women suffering from breast cancer with positive axillary lymph nodes. In recent years, of course, with the application of the sentinel node biopsy, we avoid radical dissection that used to happen in all cases of breast cancer, so the number of lymphedema development has been significantly reduced. Using this method we have much less morbidity.

Another complicating factor is the radiation of supraclavicular lymph nodes or axillary which, when necessary, disturbs the lymphatic network side stream development process as well as fibrosis in other nodes, partial obstruction of the sinus which ultimately leads to irreversible reduction of flow of the lymph glands. However, modern methods of radiotherapy with the latest type of equipment such as linear accelerators, three dimensional radiotherapy plan designing, IMRT techniques, etc., have significantly reduce these complications.

In case of lymphedema development after axillary lymph node cleaning, the patient initially mentions a slight swelling at the upper end and a mild feeling of heaviness in the arm or forearm. When lymph fluid begins to accumulate, the ipsilateral limb swells peripherally and centrally, it hurts and develops lymphangitis or even cellulite, it becomes difficult to move, lift or bend.

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