Dr. Suresh Chaware (Plastic, Microvascular and Hair transplant Surgeon) and the team at VIMS, Hospital, and Saundaryacity, Hair transplant and plastic surgery Centre, Nagpur, performed a very rare surgery called vascularized lymph node transfer for treatment of lymphedema also known as elephantiasis this is the first case in central India.
Dr. Suresh Chaware, M.Ch. Plastic Surgery, Consultant, Hair transplant, Plastic and Microvascular surgeon VIMS hospital, and Saundarya city hair transplant center, Nagpur explained that elephantiasis or lymphedema is a condition characterized by the development of edema over the upper and lower limb mainly and other parts of the body.
In India usual causes are filariasis and after cancer surgery like breast surgery (Mastectomy) or groin node dissection or it may be congenital.
Lymphedema is a progressive disease that leads to debilitating, disfiguring, incapacitating, and is non-treatable and sometimes requires amputation of limbs. To date, there is no curative treatment for lymphedema.
Vascularized lymph node transfer is a new modality of treatment in which lymph nodes from the axilla or groin are transferred by the microvascular technique in disease limb. A new lymph node establishes contact with lymph vessels nearby and helps in reducing edema.
This is a highly specialized and complicated surgery requiring about 8 to 10 hours is done under a microscope.
There are very few reports of this surgery in India and this is the first of its kind in central India. We have performed this surgery on Rajesh, a teacher by profession from Chhindwada. He was suffering from swelling (Lymphedema) over the left lower limb for 2 years. It was very disabling and disfiguring for him.
We transferred the Vascularizedlymph node from left axilla to the left calf of the left lower limb. Over the last six months, swelling is gradually reduced and he is much relieved of swelling and results are constant.
This is the first of this surgery performed in central India at VIMS Hospital, Nagpur. In this surgery, Dr. Girish Thakre, Dr. Minakshi Hande, Anesthetist administered anesthesia to the patient.
Rajkumar, Santosh, Sukhdeo, Chanda, and other staff of operation theatre helped to carryout surgery smoothly. Dr. Rajesh Singhania and Dr. Priyadarshan Hande were part of the team.
Vascularised Lymph Node Transfer – Innovative Treatment For Lymphedema Or Elephantiasis – A Hope For Incurable Disease
INTRODUCTION: Lymphedema or elephantiasis is a disease of lymphaticvessels. As blood vessels in our body there is the third system of tine vessels which helps in the transportation of fluid from tissue specially underneath of skin are called lymphatic vessels. These vessels are connected to lymph node and to main blood vessels.
What causes Lymphedema?
If theses lymphatic vessels are damaged due to infection like filariasis, surgery like lymph node excision for cancer or congenital ( since birth) leads to accumulation of fluid underneath the skin leading to lymphedema or elephantiasis.
Why Lymphedema is serious?
Lymphedema is very debilitating, disfiguring, incapacitating, and non-treatable and sometimes requires amputation of a limb.
The person suffering from this disease become incapacitated and his mobility becomes restricted due to weight, size, and various complication like infection, cellulitis, and skin necrosis.
What is the treatment of Lymphedema?
At present, there is no curative treatment. The only treatment offered is pressure garments and treatment of complications. Few surgeries can be done but the root cause is not treated.
For this kind of incurable disease, Vascularized lymph node transfer is the only hope to cure the disease.
How Vascularise lymph node works?
Vascularized lymph nodes establish a new connection with lymphatic in surround tissue and bypassing diseases lymphatic and help in transportation of fluid accumulated in limb due to damage lymphatic vessels.
This is a very complicated and specialized microsurgery requiring specialized training in microvascular surgery
Case Report:
Mangesh (Name Changed), 52 year male patient resident of Chhindwara presented to me with complaints of swelling over the right lower limb for 6 years. The swelling was progressing and was very debilitating and disfiguring. He tried so many modalities of treatment but no respite.
Hence I decided to give him definitive and curative treatment. After a long consultation and explaining the pros and cons of the new modality- i.e. Vascularised lymph node transfer, we performed this surgery.
In this surgery, lymph node from the left axilla was harvested with blood vessel and transferred and transplanted in the right calf with microvascular surgery. The surgery lasted for 8 hours and finally we were successful to transfer lymph node. After 8 days of hospitalization, he slowly resumed his routine work, and edema of limb started reducing.
In this surgery, Dr Girish Thakre, Dr Minakshi Hande, Anesthetist administered anaestheisia to patient. Rajkumar, Santosh, Sukhdeo, Mrs Chanda, and others in the operation theatre helped to carryout surgery smoothly. Dr. Rajesh Singhania and Dr Priyadarshahande were part of the team.
