Lymphorrhea is the light amber colored fluid that drains from open skin areas (wounds) on a lymphodemous limb. It is not normal plasma, but is a protein-rich substance that can lead to serious complications for the lymphedema patient. The composition of lymphorrhea is approximately 1.0=5.5 g/ml of protein.
Causes of Lymphorrhea
The cause of lymphorrhea drainage is any open area or break in the skin of the lymphodemous limb. Any opening, no matter how small will cause this fluid to weep or drain. Insect bites, cuts, abrasions, cracks in the skin from dryness, wounds of any type become a source for leakage of this fluid.
There are two serious complications that arise from lymphorrhea.
The fluid is a natural "food-source" for bacteria. The open draining wound becomes what is referred to as an entry foci for bacteria. This leads to cellulitis, lymphangitis or erysipelas.
Lymphorrhea is highly caustic to the skin tissue that it come into contact with. Untreated wounds with this drainage can very quickly become large gaping areas that may eventually lead to the need for skin grafts.
further information on lymphorrhea and wounds associated with
lymphedema see our
Lymphorrhea - What Is It
Lymphorrhea is an escape of lymph from a cut, torn, or burst blood vessel onto the surface of the skin. Lymph is a milky fluid that contains proteins, fats, and white blood cells (which help the body fight off diseases). Blood vessels are tube shaped structures that carry blood to and from the heart. Lymphorrhea is also known as lymphorrhagia. Lymphorrhea comes from the Greek word "lympha" meaning "spring water," and the Greek word "rhoia" meaning "a flow." Put the words together and you have "a flow (of) spring water."
This article is taken from the Winter 2002 issue of LymphLine
By LSN Trustee and Nursing Advisor, Denise Hardy
What is Lymphorrhea?
Lymphorrhea is the leakage, or weeping, of lymph fluid through the skin surface. Large beads of fluid appear on the skin and trickle from the affected areas.
Causes of Lymphorrhea
May be the result of lacerations, abrasions, or trauma of the altered dry skin of longstanding edema e.g. graze/cut
It may result from the rupture (bursting) of lymphangiomas (described more fully below)
It may also occur in a sudden or acute edema (swelling) where the shiny, taut skin has stretched so rapidly that it splits, forming a leak.
Lymphorrhea - the complications it causes
The skin feels very cold, wet and uncomfortable. The fluid can soak through dressings which may need changing many times a day to cope with the large amounts of leakage The fluid can collect in shoes/slippers… clothing and bed linen can become soaked and require frequent changes
Lymphorrhea will increase the risk of cellulitis - the break in the skin acts as an entry for bacteria. Infection will cause further problems (pain/inflammation/flu-like symptoms and increased amounts of fluid leakage)
If left to leak and dressings are not regularly changed the lymph (being an excellent culture medium) may grow bacteria causing odor and discoloration
Lymphorrhea may cause social difficulties and embarrassment.
Lymphorrhea not uncommonly affects the genital area and may be difficult to distinguish from urinary incontinence.
Treatment of Lymphorrhea
In order to stop the fluid leaking, a series of steps are essential.
Your lymphedema nurse/therapist or other nurse involved in your care should be able to help you with these steps following a full assessment of the cause of the leakage:
The area around the 'leak' needs to be cleaned carefully to ensure the risk of infection is reduced.
An emollient (moisturizing cream/lotion) should be applied to the skin to improve the condition and protect it (by acting as a barrier) against further skin breakdown.
A non-adherent (non sticky), absorbent, (e.g. Allevyn/Cutinova/lyofoam) sterile dressing should be applied to the leaking area to prevent further trauma to the skin - and to absorb the leakage.
Pressure should be applied. For example a limb should be supported with appropriate bandaging e.g. Multi Layer Lymph edema Bandaging (MLLB) with short stretch compression bandages. This normally stops the flow of leakage within 24-48 hours. Bandages may have to be replaced frequently during this period of time to remove wet bandages/ dressings and to prevent further skin breakdown. MLLB should continue until the skin condition has improved enough to wear your stockings/sleeve again.
At rest, the affected limb should be elevated to reduce the effects of gravity.
Once the leakage has stopped, and the skin condition has improved, your usual compression garment should once again be applied. The garment will keep the swelling to a minimum and prevent any further 'leaks' appearing.
Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy, Fabio.email@example.com.
To evaluate the incidence of lymphoceles, lymphorrhea, and lymphedema after systematic pelvic lymphadenectomy in patients who underwent laparoscopic or open abdominal staging for endometrial cancer.
A total of 138 consecutive women who underwent systematic laparoscopic pelvic lymphadenectomy for endometrial cancer staging were compared to 123 historical control subjects staged via an open approach. Postoperative screening for lymphadenectomy-related complications by ultrasound was consistently performed.
The incidence of perioperative complications was lower in cases than in control subjects. Overall, lymphoceles were diagnosed in 19 (15.4%) and 2 (1.4%) patients who had open and laparoscopic staging, respectively (odds ratio 12.42; 95% confidence interval 2.82-54.55; P < 0.0001). Symptomatic lymphoceles were more frequent after open staging than after laparoscopy (P = 0.028). Lymphorrhea occurred in 1 and 4 patients after laparoscopic and open surgery (P = 0.19). No difference in the incidence of lymphedema was observed.
Our findings suggest that laparoscopic endometrial cancer staging is associated with a lower occurrence of both asymptomatic and symptomatic lymphoceles compared to open surgery.
5nd Department of Surgery, Areteion Hospital, University of Athens, Athens, Greece. firstname.lastname@example.org
Postoperative lymphorrhea is a major complication of axillary lymphadenectomy. The aim of our study was to evaluate the impact of type I collagen in postoperative lymphorrhea in mastectomy patients.
Eighty patients that underwent modified radical mastectomy for breast cancer were randomized in two groups. In group A (collagen group, n = 42) collagen type I (Cellerate RX powder) was applied in the axillary cavity after lymphadenectomy while in group B (control group, n = 38) lymphadenectomy was performed in the standard fashion without the use of a sealant. Suction drains remained in place until the daily amount of lymphatic drainage fell under 30 ml. The total amount and the duration of drainage, as well as the morbidity and severity of arm pain were compared in the two groups.
There was a non significant trend towards lower overall drainage in the collagen group. The duration of drainage and postoperative pain were similar in the two groups, as was morbidity. Subgroup analysis of patients according to the number of lymph nodes excised, revealed significantly less lymphorrhea in terms of volume and duration in patients who had more than ten lymph nodes excised.
Collagen type I (Cellerate RX powder) appears to attenuate postoperative lymphorrhea in patients undergoing axillary lymphadenectomy especially when > 10 lymph nodes are removed.
Yoshihiro Inoue, Michihiro Hayashi, Fumitoshi Hirokawa, Nobuhiko Tanigawa, Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan.
A peritoneovenous shunt has become one of the most efficient procedures for intractable ascites due to liver cirrhosis. A case of intractable ascites due to hepatic lymphorrhea after hepatectomy for hepatocellular carcinoma that was successfully treated by the placement of a peritoneovenous shunt is presented. A 72-year-old Japanese man underwent partial resection of the liver for hepatocellular carcinoma associated with hepatitis C viral infection. After hepatectomy, a considerable amount of ascites ranging from 800-4600 mL per day persisted despite conservative therapy, including numerous infusions of albumin and plasma protein fraction and administration of diuretics. Since the patient's general condition deteriorated, based on the diagnosis of intractable hepatic lymphorrhea, a subcutaneous peritoneovenous shunt was inserted. The patient's postoperative course was uneventful and the ascites decreased rapidly, with serum total protein and albumin levels and hepatic function improving accordingly.. For intractable ascites due to hepatic lymphorrhea after hepatectomy, we recommend the placement of a peritoneovenous shunt as a procedure that can provide immediate effectiveness without increased surgical risk.
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 Japan. email@example.com
Primary lower extremity and genital lymphoedema (GL) is difficult to manage, especially when complicated with severelymphorrhea. With abundant experience of treatment for lower-extremity lymphoedema (LEL), we performed simultaneous multi-site lymphaticovenular anastomoses (LVAs) for GL with severe lymphorrhea. In two cases of primary LEL and GL, LVAs were performed via 2-cm-long skin incisions using two to three operating microscopes under local anaesthesia. Symptoms of oedema and lymphorrhea improved clinically. LVA is a minimally invasive surgery, which is effective for the treatment of LEL and GL even in primary cases with severe lymphorrhea. Simultaneous multi-site LVAs can serve as the most effective therapy for lymphoedema.
Groin lymphorrhea complicating
revascularization involving the femoral vessels.
Roberts JR, Walters GK, Zenilman ME, Jones CE.
Division of Vascular Surgery, Francis Scott Key Medical Center, Baltimore, Maryland 21224.
Seven (4%) of 193 patients developed lymphoceles in 8 (2%) of 316 groin wounds after 211 arterial reconstructive procedures. Included were 91 aortic, 15 extra-anatomic, and 105 infrainguinal revascularizations. Lymphoceles developed in otherwise uncomplicated wounds in 6 (8%) of 73 patients with oblique incisions and bilaterally in 1 (1%) of 120 patients with vertical incisions (p = 0.01). This difference may be related to the surgical technique, with increased lymphatic damage and inadequate wound closure in the oblique approach. No increased incidence of lymphorrhea was noted in those patients undergoing aortic reconstruction regardless of the type of incision used (p = 0.15), or when compared with patients who had undergone extra-anatomic or infrainguinal bypass (p = 0.14). Each lymphocele was persistent, and external fistulas spontaneously occurred in three. Diagnosis was based upon clinical awareness and the appearance of the groin mass. Conservative management was uniformly unsuccessful, and operative ablation of the lymph fistula and lymphocele proved to be definitive therapy.
Prevention of Lymphorrhea by Means of Fibrin Glue after Axillary Lymphadenectomy in Breast Cancer: Prospective Randomized Trial
Y. Françoisa,b, A.C. Sayag-Beaujardb,c,
O. Glehenb, A. Brachetb,
a Department of Surgery, Centre Hospitalo-Universitaire Lyon-Sud, Pierre-Bénite,
b Laboratoire Recherche Oncologie, Université Lyon-1, Oullins, and
c Department of Anesthesiology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
A prospective randomized trial was carried out to evaluate the efficacy of fibrin glue in preventing lymphorrhea after axillary lymphadenectomy in breast cancer. One hundred and eight breast cancer patients, operated on by two senior surgeons, were randomized into two groups: group 1 (n = 58) without fibrin glue and group 2 (n = 50) with 2 ml of fibrin glue applied to the axillary dissection area at the end of the lymphadenectomy procedure. Early postoperative morbidity was 2/58 and 0/50 in groups 1 and 2, respectively. Mean daily postoperative drainage was significantly greater in group 1. The mean cumulative drainage quantity 6 days after the operation was 407.8 ml and 214.4 ml in groups 1 and 2, respectively (p = 0.001). The mean postoperative hospital stay was 10.1 days and 8.0 days in groups 1 and 2, respectively (p = 0.006). One delayed seroma was observed in each group. Fibrin glue seems to reduce daily postoperative drainage and hospital stay, but did not affect delayed seroma formation after axillary lymphadenectomy for breast cancer.
Department of Surgery, CHLS
F-69495, Lyon Pierre-Bénite Cedex (France)
Tel. +33 4 78 86 13 75, Fax +33 4 78 86 33 43
A case of refractory inguinal lymphorrhea cured by lipiodol lymphangiography
Gan To Kagaku Ryoho. 2007 Nov
Dept. of Gastrointestinal Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka Prefectural Hospital Organization.
We report a case of inguinal lymphorrhea cured by Lipiodol lymphangiography. The patient was a 80-year-old female who underwent an abdomino-perineal resection with lateral pelvic lymph node dissection and inguinal lymph node extraction for anal canal cancer. Histologically, the tumor was a poorly differentiated adenocarcinoma and considered to be stage IV (a2, n3 (+), P0, H3, M (-), cur C) in the Japanese classification of colorectal cancer. We recognized a lot of lymph node metastases in dissected lateral pelvic lymph node and inguinal lymph node. By hepatic arterial infusion using 5-FU (1250 mg/body weekly), the liver metastases had a complete response after 15 courses. She noticed a left inguinal lymph node swelling and an elevation of serum CEA level (79.5 ng/mL) was observed. There was no evidence of recurrence except left inguinal lymph nodes. She underwent a left inguinal lymph node dissection. Serous discharge from a surgical site persisted despite of conservative therapy such as compression. She received lymphangiography using 8 mL of Lipiodol from left dorsum of foot. We found three lymph ducts heading to left groin and observed a lot of Lipiodol leakage from ducts. We determined not only the site of leakage but we also confirmed a gradual decrease and a complete stop of lypmphorrhea in 7 days after lymphangiography. Slight lymph edema of left lower extremity appeared but gradually relieved. Lymphangiography using Lipiodol helps determine the site of leakage and may be an effective therapeutic modality for treating refractory lymphorrhea.
Lymphorrhea responds to negative pressure wound therapy
J Vasc Surg. 2007 Mar
Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, and Veterans Affairs New Jersey Health Care System, Newark and East Orange, NJ, USA.
Lymphoceles and lymph fistulas are common complications of femoral exposure for vascular procedures. Three patients who required readmission after their vascular interventions were treated with negative pressure wound therapy. Once adequate control of the drainage was obtained, the patients were discharged home with a portable suction unit. The mean time to stop lymph leak was 14 days, and the mean length of hospital stay was 7.3 days. This method of management offers early control of fluid drainage, rapid control of the wound, earlier closure, and the potential for reduced length of stay. Patient acceptance and convenience may be enhanced by outpatient management and return to work in appropriately motivated individuals.
Octreotide in the treatment of lymphorrhea after renal transplantation: a preliminary experience.
Transplant Proc. 2006 May
General Surgery and Organ Transplantation, University of Parma, Italy.
BACKGROUND: Lymphorrhea is a minor complication after kidney transplantation but may develop into a lymphocele and prolong hospital stay. Treatment is conservative based on percutaneous drainage until lymphatic leakage cessation. It has been reported that octreotide has beneficial effects to treat lymphorrhea after axillary node dissection and excision of lymphatic malformations. The aim of this study was to report preliminary experience about octreotide treatment in lymphorrea after kidney transplantation.
MATERIALS AND METHODS: This retrospective study included 20 recipients of cadaveric kidney allografts with posttransplant lymphorrhea including 10 treated with instillation of povidone iodate solution, and the other 10 with octreotide (0.1 mg three times a day subcutaneously). We reviewed the daily amount of fluid collection, duration of lymphorrhea, complications, lymphocele formation, rejection episodes, graft outcomes, and hospital stay.
RESULTS: The average duration of lymphorrhea was 8.5 (+/-4.5) and 16.3 (+/-7.3) days for the octreotide versus the povidone groups, respectively (P = .001). No complications occurred among the octreotide group, while three lymphoceles grew among patients treated with povidone solution. No differences were observed for acute rejection episodes or renal function between the groups. No octreotide-related adverse events were noted.
CONCLUSION: The mean length of lymphorrhea was lower with octreotide versus iodate povidone solution treatment. There was a shorter hospital stay and minor patient discomfort. In conclusion, lymphatic leakage after kidney transplantation may be successfully managed by octreotide administration.
Octreotide in the treatment of lymphorrhea after axillary node dissection: a prospective randomized controlled trial.
J Am Coll Surg. 2003 Mar
University of Ferrara, Department of Biomedical Sciences and Advanced Therapy, General Surgery Division, Ferrara, Italy.
BACKGROUND: Axillary lymph node dissection for staging and local control of nodal disease is an integral part of breast cancer therapy. Lymphorrea is a serious and disabling complication of axillary lymphadenectomy, but no effective therapy is currently available. Octreotide is a hormone with general antisecretory effects that has been used to control lymphorrhea in thoracic duct injury and after radical neck dissection. The aim of the study we describe in this article was to determine whether octreotide has a role in the treatment of post axillary lymphadenectomy lymphorrhea.
STUDY DESIGN: This is a prospective randomized controlled trial. Two hundred sixty-one consecutive patients with various stages of breast cancer who underwent axillary lymph node dissection were randomized and followed for 7 years. The treatment group received 0.1 mg octreotide subcutaneously three times a day for 5 days, starting on the first postoperative day, while the control group received no treatment. Of the 261 patients undergoing axillary node dissection, 136 were assigned to the control group and 125 composed the treatment group. The control group and the treatment group were evaluated for amount and duration of lymphorrhea as well as inflammatory and infectious complications.
RESULTS: In the control group, the mean quantity (+/- standard deviation) of lymphorrhea was 94.6 +/- 19 cc per day and the average duration was 16.7 +/- 3.0 days. In comparison, the mean quantity of lymphorrhea in the treatment group was 65.4 +/- 21.1 cc (p < 0.0001) per day and the average duration was 7.1 +/- 2.9 days (p < 0.0001). We did not find an important difference in the number of infectious complication or hematomas formation between the study groups.
CONCLUSIONS: Octreotide can be used successfully for the treatment of post-axillary dissection lymphorrea, and potentially, in the prevention of post-axillary lymph node dissection lymphosarcoma, since the amount and duration of lymphorrhea in this setting are known to be important risk factors for its development. Potentially, octreotide might be used in similar situations where lymphorrhea is detrimental, such as peripheral vascular surgery and regional lymph node dissection for melanoma. Copyright 2003 by the American College of Surgeons
Successful treatment of refractory hepatic lymphorrhea after gastrectomy for early gastric cancer, using surgical ligation and subsequent OK-432 (Picibanil) sclerotherapy.
Gastric Cancer. 2004
The Second Department of Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
Key words: Hepatic lymphorrhea - Gastrectomy - Surgical ligation - OK-432 (Picibanil) sclerotherapy
Postoperative hepatic lymphorrhea is a very rare complication after abdominal surgery. Hepatic lymphorrhea, not containing chyle, involves an internal lymph fistula between the lymphatic channels toward the cisterna chyli and the peritoneal cavity. Over the past 20 years, 17 cases have been reported in Japan. Here, we report a further case, of a patient with successfully treated intractable hepatic lymphorrhea following gastrectomy for early gastric cancer. We review 18 cases, including the present case, with respect to the management of postoperative lymphorrhea refractory to conventional medical treatment.
Pathogenesis and treatment strategies for lymphorrhea and lymphocele after vascular surgeries on the lower extremities
Khirurgiia (Mosk). 2004
Nauchnyĭ tsentr serdechno-sosudistoĭ khirurgii im. A. N. Bakuleva RAMN, Moskva.
From 1995 to 2003 lymphatic complications (lymphorrhea and lymphocele) after different vascular surgeries on the lower extremities were seen in 57 (4.6%) patients. All the methods of therapeutic and surgical treatment of lymphorrhea and lymphocele are presented. Problems of surgical policy and some aspects of pathogenesis of these complications are regarded. Ethiopathogenetic classification of lymphatic complications is proposed. Creation of lymphovenous anastomosis is regarded as the most promising method. This surgery was performed in 31 patients, efficacy was 96.8%. The method permits one to stop inflow of lymph into lymphatic cavity and to avoid lymphedema after surgery. Other methods of treatment have various efficacy.
Minocycline sclerotherapy for lymphorrhea following neck dissection
Nippon Jibiinkoka Gakkai Kaiho. 2003 Feb
Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo.
Postoperative cervical lymphorrhea is a complication uncommonly encountered following neck dissection for which several treatment modalities have been described in the literature. We managed 8 cases of lymphorrhea after neck dissection by injecting Minocycline through a drainage tube. We attempted this procedure for lymph discharge that had continued despite pressure dressing and systemic management with nutritional modification for about 1 week. This treatment rapidly resolved lymph discharge in 6 of the 8 cases. No patient required surgical intervention. Minocycline sclerotherapy has typically been used to treat pleural effusion, ascites, pneumothorax, and other cystic diseases of the liver, pancreas, and kidney. In many cases, this therapy brings rapid resolution. This inefficiency is due to the acidity and toxicity of Minocycline. No major adverse effects have been reported. We believe that Minocycline sclerotherapy is effective for rapidly resolving lymphorrhea following neck dissection and use of this therapy should be attempted before surgical intervention.
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