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1. I have a large hematoma in my axillary region due to surgery and radiation. Manual lymph discharge has not helped, Chikly method has not helped. Bandaging and compression have not helped. Suggestions?

Your question implies this is not a brand new issue, so I trust your physicians, including your surgeon and radiation oncologist, have examined the area of concern and are satisfied nothing alarming has developed. Not being able to see and examine the area of your concern and lack of some historical information puts me at a bit of a disadvantage in making recommendations. Are you describing an area of soft swelling like a water balloon under the skin? Are you sure this is a hematoma? Is it a hematoma that never went away or one that keeps recurring?
Hematomas develop when blood leaves blood vessels and collects in the body's soft tissue, hollow cavities or organs; likewise seromas develop from a collection of interstial fluid. The body's physiologic response is one of containment through fibrous formation and resolution through repair and removal. Not all fibrous material is always removed leading to scar formation.
My best guess is you are describing fluid within an area of thickening after surgery and radiation in an area troubled in the past by hematoma and/or seroma formation. Healing from surgery involves scaring of tissue. Radiation treatments burn skin and tissue inciting inflammation leading to swelling, thickening and scarring. The fluid collection is from overproduction and/or faulty removal in an area of complicated by scarring and thickening. The axilla is a complex body regions; mobile, subjective to webs of scar formation, and a confluence of lymphatics.
Manual lymphatic drainage (MLD) can help with the removal of fluid but not blood or scar. Depending on the reason for fluid collection, MLD will not cure the fluid buildup but can be useful in fluid control.
Bandaging and compression therapy provide counter pressure and can help with fluid formation in tissue. The axilla, a highly mobile region, is a cumbersome area to obtain adequate persistent compression.
Interventions such as MLD and compression help control but are not curative. Adequate treatment must occur every day and is lifelong. After employing the interventions you described without success, I can appreciate your frustration but would not give up.
I would recommend evaluation by a manual lymphatic therapist with depth and breadth of experience and focus in treatment of the axilla after cancer treatment. I would seek out a therapist who is knowledgeable, enjoys problem solving and is willing to integrate multiple modalities.

Lymphaticovenular bypass (LVP), the microsurgical technique of creating precise anastomoses between lymphatics and venules in an area of surgically induced lymphedema has been safely performed. It is one type of surgery used to treat lymphedema. Reconstructive lymphatic surgery is meant to permanently restore normal lymphatic functioning in an area of lymphedema; i.e. "cure." A recent article in LymphLink, the publication of the National Lymphedema Network, reviewed the area of surgery for lymphedema. The 2nd European Conference on Supermicrosurgery met March 2012 to discuss and exchange study on the pursuit of ideal surgical treatment for lymphedema. Additional surgical interventions included free lymph node transfer, liposuction , autologous lymph vessels transplantation , and combined surgical treatment. LVP remains under active investigation. Current areas of investigation include appropriate patient selection, timing of surgical intervention, prevention of anastomotic obstruction, mechanisms to optimize results, to name a few. Other important areas of actively being studied ongoing within the field of lymphology include: mapping of lymphatics, exploring the molecular determinates of lymphatic function, lymphatic aging. Understanding and characterizing the myriad other possibilities which cause lymphedema to develop in only some individuals is necessary to advance the field of surgical intervention for lymphedema
Not all lymphedema is the result of surgery, or even extensive removal of lymphatic vessels, so not everyone. Scientists and clinicians interested in lymphology all wish we truly understood the mystery behind the development of lymphedema. It is not just a plumbing issue. There is no set surgical intervention for lymphedema. Although further study is required to determine factors leading to anastomotic obstruction and to optimize the results of microlymphatic surgery, the present LVSEA technique appears promising. Current areas of investigation include appropriate patient selection, timing of surgical intervention, prevention of anastomotic obstruction, mechanisms to optimize results.

A review article that may be informative is “Current status of lymphatic reconstructive surgery for chronic lymphedema: it is still an uphill battle!” by Lee, Laredo and Neville R in the Int’l Journal of Angiology (2011;20:73-80).

Posted: 18 Jun 2012 09:21 AM
Originally Posted: 18 Jun 2012 09:23 AM
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