The advances of microsurgery and supermicrosurgery have enabled the development of surgical procedures focused on improving lymphatic drainage. The objective of these procedures in cases of mild lymphedema is to achieve a normal limb that does not need the use of bandages or compression systems, and in the most advanced cases of lymphedema the objective is to decrease the diameter of the limb, decreasing or eliminating the risk of cellulitis and ulcers.

Depending on the cause and degree of lymphedema, the most commonly used surgery options are lymph node transplantation and lymphatic-venous anastomoses.

In mild cases of lymphedema, where it is possible to identify healthy lymphatic vessels, the connection of these lymphatics can be made directly to the venous system in what is known as lymphatic-venous anastomosis (LVA). In this way the lymphatic drainage of the affected limb or body area is improved.

Lymph node transplantation (VLNT) is especially indicated in moderate to severe cases of lymphedema, where it is often difficult to identify healthy lymphatic vessels, and where the cause of lymphedema has usually been the resection of lymph nodes. Oncological surgery lymph nodes. In this surgery, healthy lymph nodes are taken carefully from some part of the body to place them on the affected limb. The transplanted lymph nodes work by directly draining lymphedema into the venous system. In this way the lymphatic drainage is improved, decreasing the diameter of the limb, the sensation of heaviness, the risk of local complications and the need or frequency of specialized kinesic therapy for lymphatic drainage.

In some cases it is necessary to combine the treatment of LVA with VLNT, and to help the modeling of the limb with liposuction. In extreme cases it is necessary the resection of cutaneous surplus or other resective procedures to reduce the diameter of the limb.

Para ver la entrevista en la página completa, puedes dar click en el siguiente enlace.

Doctors perform the first transplant of lymph nodes to a patient with lymphedema daily interview El Mercurio

 

Lymphoedema Microsurgery

Reconstructive Microsurgery is one of the most powerful tools to treat lymphedema. Both the transfer or transplantation of lymph nodes and the lymphatic-venous anastomoses allow a physiological improvement of the lymphatic drainage.
I share the result at 3 weeks in one of our patients. He underwent right inguinal lymph node dissection as part of the cancer treatment. He consulted us at 7 months due to the appearance of lymphedema of his entire lower right extremity. In this case, we performed a transplant of right gastroepiploic nodes to the right groin. In the photograph you can see the difference before and after the ganglion transfer.

Regards,
Dr. Ramírez.

Lymphedema treatment:

We are very happy to be able to offer our patients with lymphedema a new diagnostic tool that helps with treatment. This is the PDE, of the Japanese company Hamamatsu. This system allows us to perform lymphography with indocyanine green (ICG) to visualize the lymphatic vessels and the different patterns of lymphatic drainage. Lymphography with ICG allows us to optimize treatment with either lymphatic-venous anastomosis, lymph node transplantation or resective procedures such as liposuction or direct resections.

Regards,
Dr. Ramirez.

The lymph node transfer is one of the tools that is currently available to treat lymphedema physiologically. It can improve the contour of the affected limb, decrease the risk of infections (cellulitis) and other complications related to this condition.

I share a video summary of one of the ways to perform this surgery.
Regards!

 

HLF Plastic Surgery Team performs first Total Anatomical Breast Restoration in South America

On Friday, July 1, in the pavilions of our establishment, a total anatomical mammary restoration or TBAR was performed, this being the first time this intervention has been carried out in our country and in South America.

Said surgery was in charge of the team of Plastic Surgery and Reconstructive Microsurgery of the HLF, led by Dr. Alejandro Ramírez. The patient was a 56-year-old woman with breast cancer who had undergone a total mastectomy and axillary lymph node dissection, secondary to lymph node dissection, Mrs. Leonor Lagos, had evolved with lymphedema (swelling due to lymph accumulation) ) in the arm of that same side. In the complex surgery of 9 hours, a breast reconstruction with a DIEP microsurgical flap was performed, plus a lymph node transplant from the inguinal to the axilla (TBAR).

Mrs. Leonor Lagos (first patient to be operated on total anatomical breast restoration) with her daughter Andrea Jimenez are happy with the operation.

The goal of this surgery was both to rebuild the breast, and to treat lymphedema of the arm. According to Dr. Ramírez, “breast reconstruction with a DIEP flap is the best breast reconstruction that patients can choose, because it produces very little damage in the area where the tissue is taken (being very similar to a tummy tuck). aesthetic) and because the reconstructed breast has a natural appearance and consistency “. On the other hand, he explains that “the transplanted lymph nodes perform their function sucking the lymphedema and thus improve the lymphatic drainage of the affected limb. The benefits of TBAR are being able to reconstruct the affected breast and the lymphatic drainage of the arm in the same surgery “. Dr. Ramírez emphasizes that microsurgery to treat lymphedema is an area of ​​rapid development in the world thanks to the progress of supermicrosurgery and lymph node transplantation. “With these tools we can now treat patients who in the past could only be treated with kinesiological lymphatic drainage therapies.”

The patient did not present immediate complications and was discharged on the fifth day after surgery.

Dr. Alejandro Ramírez highlighted the incredible work done with the team of Plastic Surgery and reconstructive microsurgery of the HLF.

 

I invite you to read the complete case of Mrs. Leonor in the following link.

HLF Plastic Surgery Team performs first Total Anatomical Breast Restoration in South America

By Carlos Montes Z. Portal Multitemático Contenidos 123

In charge of the Plastic Surgeon of the Pontifical Catholic University, Reconstructive Microsurgeon trained in Taipei, with studies in Aesthetic Plastic Surgery in New York, Mr. Alejandro Ramírez, the first lymph node transplant for lymphedema was carried out in Chile.

Doctor, what can you tell us about this first transplant in the country? What does it consist of?

Regarding the procedure: Lymphedema is a debilitating disease for many patients. It consists of the accumulation of lymph in some part of the body, usually the extremities. It is indeed the first time that this surgery is performed in the country. The goal of this is to bring healthy lymph nodes where needed. These work by “sucking” the lymphedema. In this way it is improved lymphatic drainage of the affected limb, decreases its diameter, and the discomfort and associated problems. In this specific case, the patient suffers from lymphedema in her right lower extremity. He received treatment abroad with partial response, so a lymph node transplant was planned. On March 11, in a surgery of more than 9 hours, nodes were transplanted from his left armpit to the right groin. To perform the tissue transplantation, an artery, 2 veins and a lymphatic channel were reconnected under the microscope.

In charge of the Plastic Surgeon of the Pontifical Catholic University, Reconstructive Microsurgeon trained in Taipei, with studies in Aesthetic Plastic Surgery in New York, Mr. Alejandro Ramírez, the first lymph node transplant for lymphedema was carried out in Chile.

Doctor, what can you tell us about this first transplant in the country? What does it consist of?

The honest and critical vision of the patient

Camila Sapag Sánchez, 22 years old:

Tell us about your experience with transplantation.

Well, the surgery had a great medical team. An oncologist, a plastic surgeon specialized in microsurgery, my kinesiologist, anesthetist, etc. All experts in the handling of the subject. Basically, they monitored the lymph nodes of my thoracic zone, removing 3 of them without risk of generating sequels in the area. They transplanted that flap of 3 nodes in my right inguinal area joining them to keep them alive. In addition to that, I had a liposuction on the entire limb to reduce the volume. It is a slow surgery, which needs a lot of concentration and expertise because they are delicate areas, and the subsequent recovery is a bit painful and slow.

When dealing with lymph nodes, does it work with a waiting list, like a heart or lung?

It is a ganglion transfer where lymph nodes move from the thoracic area, safe place without risk of lymphatic damage, to another part of the body, in my case the groin. As a preventive measure before surgery, it is necessary to perform a lymphocycintigraphy for the marking of nodes by means of a contrast fluid, which allows during the surgery to monitor that the lymph nodes of the area where the lymph nodes are removed for transplantation are not affected. . It does not work with waiting list, but the transplant is done from the body itself. In my case, I extracted a 3-node flap from the thoracic area and transplanted it into the inguinal area connecting the new ganglia to arteries and veins. In addition, in that same union the doctor performed anastomosis.

How did you contact the doctor who operated on you?

One day I went to the El Golf medical center to have a lymphatic drainage, where my expert lymphedema expert, Angela Villella, works and she told me that Dr. Alejandro Ramirez of the Catholic University had arrived in Chile. He had gone to Taiwan one year to learn the technique of lymph node transplantation with experts in the field, so we were able to contact him and implement this type of surgery in Chile. The specialists in reconstructive microsurgery are plastic surgeons, and Dr. Alejandro Ramirez gave us confidence and security with his knowledge and management of the subject.

Before doing so, was there a plan B? I understand that you had to travel outside of Chile.

Look, I was diagnosed with lymphoedema in 2011. I came to the clinic in Urgency thinking that I had been bitten by a bug or something because I woke up with my right leg swollen. When I did the
In the relevant examinations, a vascular doctor gave me the diagnosis, telling me that it was a lifelong disease, and that the only solution was compression stockings, manual drainage and multilayer bandaging. I stayed with that for a couple of years, resigned to my condition until with the help of my mother, we began to discover that there were alternative treatments, that there were options to improve the quality of life but unfortunately not in Chile and very high cost. We communicated with the United States, Argentina, but finally decided to travel to Spain where they welcomed us very well, where we can see the interest of the doctors and the inclusion of the pathology in the health service. In Spain, Dr. Lasso gave me 5 lymphatic-venous anastomoses (connecting lymphatic vessels to the veins) and I got an improvement. I reduced the swelling of my leg, not quite but it did relieve me a lot and prevented the volume of my leg from increasing. With that, we also discovered that not only can a single intervention be performed, but that one can try one, two, three times, even combining techniques. It is very sad that in Chile Lymphedema is not an issue that is on the table of topics doctors, because countless women who are victims of breast cancer end up with Lymphedema in one arm, or me in my case due to medical negligence, due to the biopsy of an ingrown ganglion in which there was an extraction of a large mass ganglionar without having the required precautions, producing obstruction in the lymphatic drainage; even more, the result of the Biopsy did not show any pathology, leaving Lymphoedema as a consequence of this intervention. The doctors in our country are not informed of the advances that exist in the treatment of this disease and that in a certain way causes patients to be condemned to a poor quality of life, to lock themselves in their condition and feel hopeless and alone. Not only are there secondary lymphedemas, there are also primary lymphedemas that are congenital. My case is secondary, because it is a product of poor manipulation of the lymph nodes in a biopsy.

Once recovered, normal life?

Absolutely. Two weeks of relative rest, then continue with sessions of manual lymphatic drainage and bandages multilayers but with full mobility and possibility of a normal life. Yes, it must be said that Lymphedema generates a degree of disability because it makes it impossible to perform certain activities, especially when one is young. I mean, I can’t do a lot of bouncing, I can not go for long walks because it’s inflamed, and I have to have certain precautions like not getting hurt, because there are many risks that go hand in hand with Lymphoedema. On the other hand, I’ve always told myself that I’m not going to change because of the disease. Yes I adapt to it but in no degree I have stopped doing the activities that I like. For example, I’m camping for a couple of days where I know I’m going to do physical exercise and take my bandages and my things to take care of myself. You have to learn to incorporate this disease and not let it paralyze you because the psychological effect is strong. Patients tend to hide, to feel abandoned, with the statement that it is a progressive disease that has no improvement and that ultimately produces much damage to self-esteem.

To close, how does it feel to be part of the medical history of the country?

It seems relevant to me to have the privilege of being the visible face that represents so many silent, hidden, unprotected, ignored cases of people who tomorrow will have the opportunity to improve their condition, to have a fuller, happier life and that medical specialists (vascular surgeons, plastic surgeons and kinesiologists) become aware and react to the need to train, read, attend conferences and responsibly take care of many patients who are waiting to be served. I also believe it is important to insert this disease into the health system, since there is no Fonasa code or isapre coverage, and the treatments are expensive and can only be covered with our own resources. In that sense, there are people of low income who do not have possibilities of attention. I hope that my case is disseminated so that all people suffering from lymphedema see that there are alternatives, that there are doctors willing to help, who know and are informed. Let them know that the diagnosis is not as dramatic as it seems, that they are not alone and that there are a million people with the same condition. On Facebook, a group called Lymphedema Action was created, and it is impressive to see how many people have this disease and do not know how to handle it. My parents have the resources to pay for the treatments, I am lucky to be able to travel to Spain, I am lucky to be able to treat myself in Chile now, and I want all the people to have the same luck. I find it unusual that the manual drainage goes through something aesthetic and not covered by the health service, because a lymphatic drainage is not what they do in aesthetic centers, a lymphatic drainage is a medical technique that helps improve the quality of life of people overwhelmed. It can not be that only 30 kinesiologists are certified in lymphatic drainage with the number of cases that exist in our country. It can not be that there is a bad management of ganglia in any manipulation of the body, because the ganglia are fundamental for the whole functioning of the body. It can not be that one goes to a medical consultation and knows more than the doctor of the disease, that is a clear reflection of the ignorance and of the little importance that is given to this pathology in the country. I want to be part of medical history but not for scientific achievements, but for human achievements. I want the lymph node transplant, the anastomosis and the different techniques to be accessible to any person in our country, and not an opportunity that is mediated by the economic situation, because it is not fair. I am very happy with the result of the surgery, without a doubt, but I want this to be a support for this pathology so little handled in Chile, I want to provide people with contact with professionals that manage and help the treatment of the disease, and above all , I want the treatment to be easily accessible to improve the quality of life of thousands of people.

Interview: First Lymph Node Transplantation for Lymphedema in Chile