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Lymph Node Transfer
Lymph nodes are pea-size structures found throughout your body that are involved in fighting infections as well as removing harmful substances from your body. There are hundreds of lymph nodes in your body, but some are easier to feel than others, like the ones in your neck, armpits and groins. Each one of these lymph nodes are attached to a lymph vessel, that drains fluid from an area nearby, for example, lymph nodes in the armpit, mostly drain fluid from your arms and breasts and lymph nodes in the groin, mainly drain fluid from your legs.
Occasionally, lymph nodes have to be removed as part of your cancer treatment, to control the spread of disease. Once the lymph drainage from your arm or leg is disrupted, you may develop lymphoedema, requiring constant garments. In cases like this, you may be suitable for a form of lymphoedema surgery, called lymph node transfer (LNT). In this surgery, lymph nodes are transferred from one part of your body, to another, where the lymph nodes have been removed for cancer treatment. In fact, Mr Ghattaura commonly transfers lymph nodes from the groin to the armpit. He may also consider using neck lymph nodes to transfer to your limbs.
The blood supply to the lymph nodes is reconnected in the new site and therefore this is called a vascularised lymph node transfer, providing ‘living’ lymph nodes. Over time, the lymphatic vessels from the transferred lymph nodes reattach to the current lymphatic system and start to drain the fluid from your leg or arm. The surgery also aims to release tight scar tissue in the armpit or groin and improve overall limb movement.
Mr Ghattaura specialises in ‘own tissue’ transfer, though his work performing complex microsurgical breast reconstruction. He uses these same skills to transfer lymph nodes from one part of your body to another. In some cases he transfers the lymph nodes at the same time as the tummy-based breast reconstruction.
What’s involved in the procedure?
Since this is complex, lengthy microsurgery, you need to be generally fit and healthy, with no significant medical problems. To start with, Mr Ghattaura carefully identifies the right lymph nodes to transfer, understanding the need to avoid lymphoedema in the area from where he is taking nodes. This can be achieved through a process called reverse mapping, using dye and an infrared camera. This allows him to identify the lymph nodes draining critical areas (legs, arms) and avoid these. The lymph tissue is then carefully detached from the groin or armpit, with its blood supply, preserving the critical lymph nodes draining the limbs. These lymph nodes and attached blood vessels are then transferred to the new site, before being reconnected to blood vessels there. The surgery takes about 3-5 hours, with a 2-day stay in hospital. The transferred lymph nodes may also contain a patch of visible skin, so Mr Ghattaura can check the lymph nodes are working well in the days after surgery.
Lymph node transfer is a highly effective surgical treatment for patients with lymphoedema, replacing missing lymph nodes removed through cancer treatment with the aim of restoring normal lymphatic drainage. Most patients notice a reduction in the size and swelling of their limb within 3-6 months.