Originator: Joy LewisDate: October 2011

Version: 2Date for Review: October 2014

DGOH Ref No: DGOH/PIL/00523

LymphoedemaVascular SurgeryPatient Information Leaflet

2 7

What is lymphoedema?We all have a small amount of fluid (lymph) in our body tissues.This fluid leaves our blood system to provide water andnourishment to the tissues. Most of this fluid is collected by asystem of drainage tubes, similar to blood vessels, called thelymphatic system.

Lymphoedema is swelling which is due to a build up of lymph in thelimbs if the fluid is not draining out properly. To start with theswelling is often noticeable at the end of the day and goes down atnight. However, unless the swelling is treated properly, the fluidbecomes fixed in the leg permanently.

What causes lymphoedema?The most common cause for lymphoedema is that you were bornwithout enough lymphatics. If there are very few lymphatics thenthe swelling may start as a teenager or even earlier. This type oflymphoedema is called Milroy's Disease. One leg is often worsethan the other and sometimes only one leg is affected.

In less severe cases the lymphatics may be able to cope nitiallyand only start to fail when you are older. This kind is sometimescalled Lymphoedema Tarda.

Further help and informationThe Circulation FoundationWeb: www.circulationfoundation.org.ukwww.patient.co.uk

Access to benefitsIf you require information about benefits information can be foundonwww.direct.gov.ukwww.dwp.gov.ukor your local Benefits office.

6 3

Are there any other causes?Lymphoedema can also be caused if the lymphatics of the arm andleg are damaged by surgery or radiotherapy for the treatment ofcancer. Sometimes this is unavoidable if the cancer is to be cured.

There are also some rare tropical parasites (Filariasis) that invadeand block the lymphatics. These parasites do not live in GreatBritain.

What effects does lymphoedema have?Apart from the uncomfortable and unsightly swelling, lymphoedemacan cause problems, especially if it is not kept under control. Thereis an increased risk of infection under the skin (cellulitis) andrepeated attacks of cellulitis lead to more lymphatic damage. Thisvicious circle may eventually lead to severe infections, ulcers andeven amputation in extreme cases.

What is the treatment?Lymphoedema cannot be cured but it can usually be controlled sothat complications do not occur later. The mainstays of treatmentare compression bandages or stockings, elevation of the limb andexternal pneumatic compression.

Vascular team contact detailsIf you require any further information regarding please contact oneof the Vascular nurse specialists or the consultant managing yourcondition via the following telephone numbers.

Mr Jayatunga - Consultant Vascular SurgeonSecretary - Alison Slater Tel no - 01384 244243

Mr Patel - Consultant Vascular SurgeonSecretary - Joanne Webb Tel no - 01384 244021

Mrs Shiralkar - Consultant Vascular SurgeonSecretary - Faye Langford Tel no - 01384 244246

Mr Pathak - Consultant Vascular SurgeonSecretary - Maxine Winmill Tel no - 01384 244245

Mr Rehman - Consultant Vascular SurgeonSecretary - Lara Golding Tel no - 01384 244176

Joy Lewis - Vascular Nurse SpecialistTel no - 01384 456111

Mark Black - Chief Vascular Scientist or Darren Rhodes - VascularTechnologist Tel no - 01384 456111

Elevation of the limbWhenever the leg is elevated, fluid will tend to drain out of it. Putyour legs up whenever you can and as high as you are able - thearm of a sofa is good. Elevate the end of your bed (6 inches or so)in order that your feet are a little higher than your head. You canuse some old books for this.

Compression bandages or stockingsCompression is required to squeeze the fluid out of your legs whenyou are standing up. Bandages may be required at first, to removethe worst of the swelling, before stockings can be used. Thesestockings need to be specially fitted and are much stronger thanordinary "support tights".

If the swelling only affects the lower leg, then you can wear abelow-knee stocking that is self-supporting, like a pop-sock. Theusual strength of stocking used is a Class II, but sometimes astronger Class III is required. If you have difficulty putting on yourstockings, then you can buy a special stocking applicator.

External Pneumatic Compression (EPC)Despite compression stockings, many people find that someswelling accumulates by the end of the day. The EPC device is apneumatic boot that inflates and deflates to squeeze fluid out of theleg. EPC is normally used in the evening to get rid of any fluid thathas built up despite compression stockings. If your doctor thinksyou need EPC therapy, a trial of the device will normally bearranged so that you can decide whether it is worth buying one.

What about surgery?Many operations have been tried to cure lymphoedema, but nonehave been successful. Surgery to reduce the size of the lower leg(Homan's Reduction) may be suggested if your leg remains veryswollen despite compression therapy.

How can I help myself?Wear your compression stockings every day from morning tonight

Elevate your legs whenever possible

Take plenty of exercise and do not put on weight

Keep the skin in good condition by using plenty ofmoisturising cream to prevent dryness

4 5