What to Expect From Your ICG Clinic at PRMA
PRMA is at the forefront of lymphedema treatment surgery. Surgery planning starts with a diagnostic consultation with one of our board-certified plastic surgeons. During this appointment, a dye is injected into the lymphatic system so the doctor can identify any areas of blockage.
What Are the Steps?
The first step is to numb the four injection sites using topical Aspercreme. The injection sites are located between the knuckles (one between the pointer and middle finger, and one between the ring and pinky finger) and the underside of the wrist (one toward the inside and one toward the outside of the wrist). This should sit for about five minutes.
Next, your surgeon takes a small needle and injects a very small amount of dye. The patient may feel a small burning sensation, similar to a bee sting, during the injection of the dye. The patient will then lift their arm straight up and pump their fist to help the dye travel up the arm.
Your medical team will then turn off the lights and use the camera to view the injection sites to see how the dye is traveling through the channels in real-time.
For a functioning channel, the doctor should see a linear pattern that travels all the way up the arm. This is a channel that your doctor does not want to target for an LVA, as it is functioning.
For a target channel, your surgeon would see a channel that begins to travel up the arm in a linear pattern, but then shows a diffuse pattern where the dye has spilled out into the tissue. This diffuse pattern indicates lymphedema. The doctor would target the linear line before the diffuse pattern and redirect it into a blood vessel to give the fluid another way to drain from the arm.
When the lymphedema has progressed to a more advanced stage, your doctor sometimes sees no uptake of the dye into the channels in the arm. This does not give us a target channel to use for the LVA.
Your doctor will then draw a template of the channels on a piece of paper so they can reference it before surgery.
They will perform this exact same study in the OR while the patient is under anesthesia so they know exactly where to make the incisions.
What Are My Surgical Options for Lymphedema?
At PRMA we offer the complete spectrum of upper extremity lymphedema treatment. Microsurgery is part of our daily practice and we are proud to offer our patients state-of-the-art reconstructive procedures including vascularized lymph node transfer and lymphovenous anastomosis.
Vascularized lymph node transfer involves replacing lymph nodes that were damaged or removed by previous breast cancer treatment with healthy lymph nodes from another part of the body. This can help restore the lymphatic drainage of the arm and can improve arm lymphedema.
Lymphovenous Anastomosis is one of the newest methods used to treat lymphedema and requires specialized training. The surgery is used for certain patients that have lymphedema related to breast cancer treatment.
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