MQ Health - Macquarie University

Lymphoedema Clinic

Surgical options: Lymph Node Transfer

Lymph Node Transfer (LNT) for Early Lymphoedema

Lymph node transfer is an innovative option for surgery for management of early lymphoedema. Lymph node transfer involves surgically moving lymph nodes from a region of the body or unaffected limb to a region within the limb affected by lymphoedema to try to 'kick-start' the lymphatic system. The ultimate goal of this surgery is that in time the body incorporates the new nodes and they can begin to function successfully, draining fluid naturally.

Patients will be assessed at the Advanced Lymphoedema Assessment Clinic (ALAC) by the multidisciplinary lymphoedema team (MDT) and Dr Quan Ngo to see if they would be eligible for surgery.

Eligibility criteria

  • Early stage lymphoedema. Lymphoedema diagnosis of less than 5 years
  • Nil skin changes such as fibrosis or thickening. Skin / oedema should be soft
  • There should be some fluid shift as evident by compressibility
  • Erythrocyte sedimentation rate (ESR) within normal range (less than 100)
  • The operation will take 5-8 hours at Macquarie University Hospital.

The goal of the surgery is to improve lymphatic flow with the aim of reducing compression garment wearing time.

Surgery can be done at the completion of chemotherapy or radiotherapy following breast cancer treatment.

Precautions/contraindications and specific patient parameters

Main complications:

  • General surgical complications – bleeding, infection, poor scar/healing, damage to adjacent vessels / nerves which may result in some sensory deficit or muscle weakness
  • A small patch of numbness may occur over the inside of the thigh if groin nodes are harvested
  • Theoretical risk of lymphoedema to the area where lymph nodes were removed (although not yet reported in practice)
  • Complications of general anaesthesia

Post-operative care in hospital

Patients will have drains in situ similar to that of breast surgery for the first few days. They will also have a drain in their hip where the donor incision is.

Compression garments are not anticipated to be worn during hospital stay but bandaging or wrapping may be used if post operative arm swelling is problematic.

Nursing staff will frequently monitor the lymph node tissue flap during inpatient stay

Patients will remain in hospital at MUH for approximately 5 days. Optional transfer to Mt Wilga rehabilitation Hospital will be discussed if it is difficult to return home in the first two weeks post operatively.

The first 2 weeks are an important time frame for healing of the operation site. The patient must keep pressure off the transferred lymph node tissue for these first 2 weeks. In most instances this would be in the axilla. In such a case the patient will be fitted with an abduction sling which should be worn for 2 weeks. The arm can be rested in some abduction on a pillow when the patient is in bed or sitting in a chair. Arm movement is limited for this time and minimal passive/ therapist assisted shoulder movement is allowed. The patient should continue with hand, wrist and elbow circulation exercises.

Discharge information

  • Patients can return to work, lifting, driving and lymphoedema exercises from 2 weeks onwards (high intensity use of the affected arm/leg, e.g. jogging, cycling, aerobic exercises, pump classes etc. ought to be avoided for at least 1 month). 
  • Depending on the type of work and exercise a patient does this time frame may need to be adjusted. 
  • Patients must wear their abduction sling until their 2 week review at the ALAC.
  • Patients do not wear their compression garments until their 2 week review at ALAC. 
  • Patients will be given discharge information by the nursing staff regarding their drains if they are to remain in situ upon discharge (usually the axillary drain comes out after 2-3 days but the groin drain might stay in for 1-2 weeks).

After discharge from hospital

Patients are not to wear their garments for the first 2 weeks. After this time frame they can resume wearing their current garment. 

Patients are required to wear their compression garments after the initial two weeks for 24 hours per day for 6 months. Garments will be reviewed and adjusted at ongoing lymphoedema clinics.

Follow-up

Patients will be reviewed on an ongoing basis at ALAC by the MDT 2 weeks, 1 month, 3 months, 6 months, 9 months and 12 months post operatively.

Lymphoedema treatment

Patients can continue to have ongoing manual lymphatic drainage (MLD) on the affected limb however no direct manual pressure or lymphatic drainage should be performed on the transferred skin paddle for 1 month post-surgery.