Breakthrough Procedure for Lymphedema
By: LYNNE JETER
Monday, September 9, 2013 4:11 pm
Orlando Health Surgeons Bring VLNT to Florida for Lymphedema Patients
ORLANDO – Six months ago marked the advent of Florida’s first Vascularized Lymph Node Transfer (VLNT) procedure, which took place at Orlando Health under the direction of Richard Klein, MD.
Since then, Klein and his surgical team have assessed 40 patients with lymphedema, a chronic condition that leads to swelling of the arms and legs. They’ve completed a half dozen VLNT procedures, with a half dozen on the books. Because the only surgical treatment for lymphedema is so new to the United States, with few surgical teams trained to perform the complex microsurgery, many physicians aren’t yet aware of the new procedure.
“We see many patients suffering from lymphedema and no one had a cure other than conservative efforts such as massaging and compressions, so we started aggressively looking for surgical outcomes,” said Klein, who oversees MD Anderson Cancer Center Orlando’s Plastic and Reconstructive Surgery Center for Orlando Health, and received special training in Paris to bring VLNT to Florida. “This procedure has the potential to change the lives of patients affected by lymphedema who, until now, had very little options for treatment.”
Lymphedema prevents lymph fluid from draining from the tissues in the body and as a result, fluid builds up and causes swelling and soreness to one of the extremities and significantly increases the risk of infection in the affected limb. In many cases, lymphedema causes chronic wounds and ulcers and breakdown of the skin.
VLNT moves lymph nodes from one area of the body to another that’s affected by a blockage in the lymphatic vessels, relieving sufferers’ pain and discomfort and allowing them to resume their daily activities. Most insurers have covered the procedure.
Lymphedema affects 3-4 million adults and children in the United States and is, unfortunately, not an uncommon side effect of breast cancer treatment in about 15-20 percent of patients, where lymph nodes have been damaged or removed along with breast tissue in combination with radiation. Other less common causes of lymphedema include cancers where lymph nodes had to be removed as part of treatment or diagnosis, trauma to the lymphatic system, infection, and congenital disorders. In third-world countries the most common cause is parasitic infection.
Klein learned about VLNT from Corinne Becker, MD, a Paris surgeon who’s performed more than 4,000 lymph node transfers in the treatment of both upper- and lower-extremity lymphedema over the last two decades. Two years ago, Becker gave a lecture about the new treatment at a symposium in New York that Klein attended. Last November, he traveled to Paris to train with her for a week. When he returned to Orlando Health, he trained fellow surgeons Kenneth Lee, MD, and Jeffrey Feiner, MD, on the two-surgeon technique.
“The operation is very demanding because the first step is to go back to the site which nodes were taken from without damaging any nerves,” explained Klein. “There’s usually a lot of scarring in that area from previous surgeries. You have to find a small artery and vein in the location to transfer and set it into. Then, you have to harvest tissue from another part of the body without causing lymphedema in that location. Those lymph nodes must be attached to a small vein. The artery and the vein measures approximately 8.8 millimeters, so it’s a very tiny vessel. Then you’re operating under a microscope to reattach the artery and veins and sutures to put arteries together. That’s how small they are.”
The first VLNT patient, local breast cancer survivor Jean Hutchinson, is doing remarkably well, said Klein, who led the surgical team to transfer lymph nodes from Hutchinson’s abdomen to her arm pit, and reconnected arteries and veins to provide the transferred lymph nodes oxygen and nutrients to survive and develop new lymphatic tissue. She had developed lymphedema in her right arm following breast surgery and radiation, and had lived with the condition for 18 months.
“Jean is a perfect patient,” he said. “She was very enthusiastic and motivated to have this procedure done. And, she was prepared for the pre-op and post-op therapy to make it successful. Today, she’s so appreciative of how the procedure improved her life.”
Prior to the VLNT procedure, Hutchinson underwent lymphatic therapy to prepare her body for the 3-4 hour surgery. Post-surgery, she continues to undergo additional therapy to gain mobility in her arm. With new vessels and active function of the transferred lymph nodes, she saw improvement within a month or two following the surgery.
“Having the lymphedema therapy team working in tandem with the surgical team is critical. Having the entire team involved is an absolute necessity, because the operation is only one key component for VLNT to be successful,” said Klein. “Prior to the operation, the affected limb must be decongested and massaged without overwhelming the lymph nodes. It takes a trained lymphedema therapist to do this effectively pre-op and post-op. To monitor our patients’ progress, we use volume measurements to track the reduction in swelling. We also provide questionnaires involving daily living and quality of life issues to find out how we’re improving a patient’s quality of life.”
Orlando Health tapped into social media channels to broadcast the first VLNT procedure in Florida on March 11 on Twitter, Instagram and Facebook. The live feed resulted in consumer interest and an uptick in self-referrals, both locally and from out-of-state.
Even though the majority of lymphedema patients are adult females, the youngest person Becker treated with VLNT was six months old.
“You can imagine how technically difficult it is,” said Klein, whose interest in VLNT stems from family members who have had breast cancer, though fortunately none with lymphedema, and an interest in advances in reconstruction techniques.
Klein noted a tremendous need for the new procedure in third-world and developing countries for patients who develop lymphedema from parasitic disease.
“Viral lymphedema of an infectious nature is rare in this country,” he said. “We haven’t scheduled any mission trips so far, but it’s something our practice wants to incorporate down the road.”
Thank you once again for my friend in Belgium who finds these articles.. I would love to be able to hear Jean’s personal story of this procedure… I am also very happy that they are including post surgical care as part of the treatment, rather than little support other than what you organise yourself. This I feel is very important as it is an emotional roller coaster of waiting for results. Others will also be interested that insurance companies covered this procedure, where some are fighting for coverage.