National Services and Clinics
The National Team supports all HB Lymphoedema Services in Wales to manage those patients with more complex lymphoedema and those seeking further opinion or treatment options for their lymphoedema and/or lipalgia (lipoedema). There are currently three specific clinics available:
Lymphoedema Complex Clinic
These clinics are held in Cimla Health & Social Care Centre by two National Lymphoedema Specialist Therapists. If patients are unable to get to Cimla, clinics are being offered at the local lymphoedema clinics as needed. Ideally the referring lymphoedema therapist should also attend this appointment; but due to service pressures, this is not always possible. Therapists will assess the patient’s lymphoedema (or lipalgia) and try to discover what the patient’s problems are in managing their condition. We often take the treatment plan back to basics and then consider options for compression therapy that may be more suitable for that person. Before each appointment a LYMPROM© is completed as this helps the lymphoedema specialist understand what the patient’s main concerns are and to focus the session on what that person needs on that day. A range of therapy options may be discussed and information provided on where patients can access these. Types of surgery for lymphoedema may also be discussed.
ICG Scanning
Patients are injected with a dye which enables our therapists to get a better understanding of their lymphoedema. Indocyanine Green (ICG) is a dye used to help light up the lymphatics lying in the skin and is picked up by a highly specialist scanning system. The behaviour of the superficial lymphatics can be seen, and helps us understand why the lymphoedema may be behaving in certain ways. More importantly, this scan is vital if a person is going to be referred for LymphoVenous Anastomosis (LVA) surgery (providing they meet the criteria). The lymphatics from the ICG scan need to show lymphatic tubes for the surgeon to join to a vein of similar size under the skin. There is a video film that explain how the ICG scan is done, and what the LVA surgery involves: www.medic.video/w-lymph-lva
Lymphoedema Surgical MDT
This clinic is held jointly with a Consultant Plastic Surgeon. Referral to this clinic is made after a patient is seen in a Lymphoedema Complex Clinic and it is felt that they may benefit from exploring surgical options. Current lymphoedema surgery includes LVA, lymph node transfer and liposuction. Each operation has criteria that patients must meet and limitations that may exclude some from this treatment option. However, each person attending this clinic is assessed by the Consultant, who may decide that further investigations are needed before a final decision can be made as to whether or not surgery is an option. Liposuction is not available on the NHS for lipalgia or where both legs may have lymphoedema. This is due to very strict criteria set by the Welsh Health Specialist Services Committee (WHSSC) to protect the Plastics Services in Wales.
LVA
A super-micro surgical treatment Lymphatic Venous Anastomosis (LVA) may improve the symptoms of lymphoedema. We are very lucky in Wales that we can offer around 30 people per year this surgery if the full criteria is met. This criterion is set by the Welsh Health Specialist Services Committee (WHSSC). If patients do meet the criteria and have suitable lymphatics, then surgery can be offered within Swansea Bay University Health Board. Over 180 patients have benefited so far in Wales and the team are just writing up their results for publication.