Heart Valve Surgery
Coronary By-Pass Surgery
Aortic Surgery And Aneurysms
Peripheral Vascular Diseases
Lymphatic System Diseases
• Prof. Suat BÜKET, MD
• Arzum KALE, MD
• Ulusal COŞKUN, MD
• Yılmaz DENİZ, MD
• Makbule KESİCİ, MD
LYMPHATIC SYSTEM DISEASES
Lymphangitis is inflammatory condition of lymph channels occurred as a result of invasion to subcutaneous tissues. Skin wounds and fungal infection areas in hands and feet are entrance gates of bacteria to lymph channels. Trauma, shoes pinching, ingrown toenails, heel cracks also pave the way for lymphangitis. Infection usually refers to superficial lymph system. The most common causative bacteria are beta-hemolytic streptococci staphylococcus aureus. Bacteria rapidly spread throughout lymphatic vessels in subcutaneous tissue. There are exudates and hyperemic areas around the lymphatics. Infection spread through the lymphatic channels.
It is characterized by red thin lines spreading to axillary lymph nodes from epitrochlear lymph nodes in arm and from popliteal lymph nodes to inguinal lymph nodes. Redness occurs as a result of inflammatory reaction. Extensive redness, fever, sensitivity and edema are generally prevalent on that area. General body temperature rises up to 39-40 C degrees. Extremity movement facilitates spreading of bacteria along lymph channels. Local lymph nodes get swollen within 12-24 hours following the first symptoms of infections. Recovery is generally complete in acute lymphangitis. Moreover, since circulation is disrupted following recurrence infections in lymphangitis and chance of recurrence increases due to stasis. In this way, chronic and recurrent infection of lymphatic veins leads to damages of lymphatic structures. And this results in lymphedema.
Treatment should be performed with immobilization and elevation of extremities, local hot-wet, antiseptic dressing and appropriate broad-spectrum antibiotics. If there is accompanying fungal infection, it should be treated.
Swelling (edema) occurs in subcutaneous tissue as a result of failure of discharge of lymph fluid in the tissues and accordingly accumulation of lymph fluid in the tissues due to deterioration in lymphatic drainage.
There is a lymphatic circulatory system as well as artery and vein circulatory system in our body. Lymphatic circulatory system carries lymph fluid in tissues going out of vessel unlike other two circulation (arterial and venous) system to the heart. The fluid carried by lymphatic circulatory system is called "lymph fluid". Lymph fluid has 4 components as protein, water, dead cells and toxins and some fats. Approximately half of protein volume available in the blood and approximately 1-2 liters water infiltrating to tissues during blood flow returns to blood circulation via lymphatic system. If lymphatic system fails to carry this fluid to blood circulation again, fluid accumulates in tissues and this causes edema.
Lymphedema is frequently seen in legs and may be seen in arm, face, neck and outer genital area. The most common symptoms of lymphedema is tension and swelling in the area held. Furthermore, motion restriction and pain may also be present in the joints. Symptoms of lymphedema are divided into three phases:
Stage 1: Lymphedema may turn back. In this stage, swollen arm or leg is simply lifted upwards and after a while, edema generally vanishes.
Stage 2: They are automatically irreversible lymphedema. In this stage, there are increase and progressive solidification in fibrous tissue. When pressed on it, hollow does not occur on the skin.
Stage 3: Arm or leg takes the form of a column and for example, knee joint cannot be distinguished from other parts of leg. This is also called as "Elephantiasis".
Lymphedema is divided into two major groups according to formation cause and onset age.
Primary lymphedema: Primary lymphedema occurs mostly as a result of non-availability of lymphatic system in the lower part of the leg. Complaints of the patients generally start in two legs and below knee.
• It is divided into three types as Congenitcal type (from birth to first age)
• Preacox type (1-35 years of age, the most common type)
• Tarda type (35 years of age and afterwards).
Secondary lymphedema: This is a lymphedema occurred as a result of disruption of flow in lymphatic system due to acquired reasons. Trauma, recurrent infections (cellulitis, lymphangitis and parasitic diseases), surgical interventions ,metastatic malignant diseases, paralysis and some syndromes (Klippel-Trenaunay syndrome etc.) can be listed among the reasons of secondary lymphedema.
Diagnosis and Treatment
This can be diagnosed with clinic findings and examination. Clinical findings in the rest of the patients are not specific to lymphedema. For this reason, it becomes diagnosis difficult. Lymph nodes and fibrosis can be monitored by conducting an advanced examination with the devices called "computerized tomography" or "magnetic resonance" in suspicious incidents. The most accepted and golden standard method for today's lymphedema is lymphoscintigraphy.
Unfortunately, there has not been a fully healing method yet. However, in some treatment methods, progress of lymphedema treatment can be stopped or delayed. Surgery can be performed in advanced stages of lymphedema even if this is not very common. Yet, other medications and physical therapy methods should be applied to the patients operated. Medical treatment causes fewer complications and more rehabilitation is witnessed in symptoms. Antibiotic treatment in those with infection risk and edema mitigation anti-edema treatment constitute onset of medical treatment.
Purpose in lymphedema treatment is to ensure remove lymph fluid from tissues by making massages (manual lymphatic drainage) gently with hands every day for ensuring lymph flow; to prevent re-accumulation of lymph fluid in the tissue by applying compression treatment (external pressure) and to improve muscle tone by daily exercise and to assist lymphatic fluid. However, pressure varicose stockings must be worn at all times during and after exercises.