Lymph node transfer

• Early-stage lymphoedema. Lymphoedema diagnosis of less than 5 years.
• Nil skin changes such as fibrosis or thickening. Skin or 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 the length of time you will be required to wear compression garments.

Surgery can be done once chemotherapy or radiotherapy following breast cancer treatment is complete.

The main complications include:

• 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.

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

You won't need to wear compression garments during your hospital stay, but bandaging or wrapping may be used if there are any problems with swelling in your arm after the operation.

While you're in hospital, nurses will frequently monitor the lymph node tissue flap.

You will need to stay at Macquarie University Hospital for approximately five days. It may also be possible to transfer to Mt Wilga Private Rehabilitation Hospital if it is difficult to return home in the first two weeks after surgery.

The first two weeks are an important time for healing of the operation site. You must keep pressure off the transferred lymph node tissue for these first two weeks. In most instances this would be in the axilla (armpit). If this is the case, you will be fitted with an abduction sling, which should be worn for two weeks. You can rest your arm in some abduction on a pillow when you are in bed or sitting in a chair. You should limit your arm movement for this time, with the exception of minimal passive/therapist-assisted shoulder movement. You should continue with hand, wrist and elbow circulation exercises.

• You can return to work, lifting, driving and lymphoedema exercises from two weeks onwards (high-intensity use of the affected arm or leg, e.g. jogging, cycling, aerobic exercises, pump classes etc. should be avoided for at least one month).
• Depending on the type of work and exercise you do, this timeframe may need to be adjusted.
• You must wear your abduction sling until your two-week review at the the clinic.
• You won't need to wear your compression garments until your two-week review at the clinic.
• The nursing staff will give you discharge information regarding your drains if they are to remain in situ upon discharge (usually the axillary drain comes out after two to three days but the groin drain might stay in for one to two weeks).

You must not wear your compression garments for the first two weeks. After that you must resume wearing your current garment.

Once you have had your two-week review at the clinic, you must wear your compression garments 24 hours (day and night) for six months. We will review and adjust your garments at subsequent lymphoedema appointments.

Patients will be reviewed by the multi-disciplinary team at MQ Health Lymphoedema Surgical Assessment Clinic on an ongoing basis at 1, 6, 12, 24 and 36 months after surgery. You will need a repeat ICG at 12, 24 and 36 months.

You can continue to have ongoing manual lymphatic drainage on the affected limb; however, no direct manual pressure or lymphatic drainage should be performed on the transferred skin paddle for one month after surgery.