Patients with lymphedema—chronic swelling of the limbs or other areas of the body due to the damage or removal of lymph nodes—are benefiting from a unique technique being pioneered by two surgeons at Beth Israel Medical Center in Manhattan, Joseph Dayan, MD, and Mark Smith, MD, Co-Directors of the Gerald J. and Dorothy R. Friedman Center for Lymphedema Research and Treatment.
The technique, called Reverse Lymphatic Mapping, improves a microsurgical procedure, Lymph Node Transfer, in which lymph nodes are transplanted from a non-affected part of the body to the affected part. The lymph nodes then connect with the small vessels that begin filtering waste and draining fluid from the body. The mapping technique enables physicians to use new imaging technology to help them determine which lymph nodes can be safely transplanted so they do not cause lymphedema in another area of the body.
“Lymph Node Transfer safely restores the physiological function of an extremity and gives us hope for improving the function rather than just managing it,” says Dr. Smith. He and Dr. Dayan have performed 50 procedures to date. They have also consulted with surgeons in Israel and Taiwan, who have started using the technique. In Taiwan, they performed a live surgical demonstration of their technique before an audience of 150 microsurgeons from around the world.
Recently, Drs. Dayan and Smith received top honors for the “Best Presentation,” at the Northeastern Society of Plastic Surgeons Annual Meeting in Washington, D.C.
As many as one-third of all breast cancer patients, and those who have been treated for other cancers such as melanoma, develop lymphedema, which can impair normal activities and predispose people to infections. Traditionally, lymphedema has been managed with massage therapy, or by wearing compression garments that prevent swelling.
Dr. Dayan says the scientific research he and Dr. Smith are gathering about the technique will shed new light on inner workings of the human lymphatic system. “There has been very little research conducted on the lymphatic system because it’s largely invisible,” he says. “But lymph vessels are everywhere, and may have a crucial role in other disease states, as well.”
The surgeons, founding members of the American Society for Lymphatic Surgery, recently published their findings online in the Journal of Reconstructive Microsurgery.
According to Lester Silver, MD, Chief of Plastic Surgery at The Mount Sinai Hospital: “There are many patients whose lymph nodes are absent or not functioning, who will greatly benefit from this procedure. By reducing the swelling in their limbs, patients have less pain, fewer infections, and a more comfortable lifestyle.”