What you need to know when choosing Surgery

Description: 

Lymphedema patients who have failed conservative management with CDT may be candidates for more novel surgical interventions to address lifestyle-limiting extremity lymphedema. Selection for surgery is done on a case-by-case basis and is directed by the care-providing surgeon according to their specific and personal practice patterns.

Generally, lymphedema patients interested in surgical options must appear in person for a through evaluation at our Centers of Excellence in Lymphedema Care prior to enrollment. Preparation for such an evaluation includes telephone and web-based questionnaires documenting presenting symptoms, past treatment for lymphedema, past and present medical conditions and a list of all current medications and allergies. You will be asked to provide documentation of all prior surgical interventions, associated pathology reports and recent photographs of your affected limbs prior to your initial consultation. Patients are encouraged to provide discharge summaries of all prior lymphedema therapies, although we acknowledge this is not always possible.

A 4-limb injection lymphoscintigraphy may be required before your in-person consultation at our Center. This test includes the dermal injection of a radioactive tracer in the hands and feet with sequential radiographs taken 1 hour and 4 hours after injection. We will coordinate this study for you in your consult city and prefer that you not have this testing done at home as most hospitals lack the required expertise.

All patients undergo a detailed consultation with the care-providing surgeon to include an extensive discussion of your unique situation. This includes a physical examination, limb circumferential measurements, dedicated vascular examination and digital photography. Appropriate surgical options will be presented to you in addition to a detailed discussion of associated short and long-term potential complications. It is important to bring someone with you to your consultation to serve as your "second set of ears". Please allow 2-3 hours for your consultation with your surgeon.

If you are selected for a surgical intervention, you will be guided through your pre-operative evaluation by one of our Personalized Care Providers. This evaluation includes specific blood tests, chest x-ray, urinary analysis and EKG that may be done at home. Some patients may require additional testing given associated medical conditions. Specialty-specific consultations with cardiology, hematology and chronic pain management will be determined on a one-on-one basis at the time of your initial consultation. Please know that it is not uncommon for us to ask for a medical clearance from your home primary care provider as well as identifying a home "Helper Doctor" to assist you with wound surveillance and drain removal after your return home after surgery.

All patients are unique and require personalized care plans to address their distinct situation. However, with this being said, our Centers of Excellence in Lymphedema Care have developed Procedure-Specific Care Maps to affect cost-containment, efficacy and seamless data collection for ongoing clinical outcomes research. Your Personalized Care Coordinator will be able to address your unique care plan to include the time you will need to stay at our Centers based on your specific surgical procedure and stage of lymphedema.

Most surgical options require specific post-operative care that may include CDT at our Center and at home. Foam-based compression bandages will be provided to you at the time of surgery. All patients are reminded to wear lymphatic compression garments or bandagers when traveling by plane to and from our Centers for all consultations and surgery.

All surgical patients undergo a comprehensive education program in the peri-operative period at our Centers to prepare them for home self-care after surgery. Family members and home care-assisters are invited to participate.

All forms of surgery carry with them associated complications. Your care providing surgeon will be available to you at the time of your initial consultation and at all times thereafter to address your unique situation and risk of surgery. Please feel free to bring a list of questions with you to your consult to ensure that we address all of your concerns.