الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSION
Lymphedema is a common and senous complication alkl”
radical mastectomy. It’s believed that it is the most distressing and
unpleasent for the patient and particulary frustrating for the surgeons.
The incidence varies from study to other. However, some
surgeons reported a high incidence which may reach 62.5%, and it
was found that the incidence was increased with longer period of
follow-up. The aeliology of postmastectomy lymphedema is a
complex, and is not fully understood. It may be due to excessive
extirpation or destruction of lymph nodes and lymphatic collectors in
the axilla; and inability of this lymphatic collectors to regenerate,
leading to reduction in lymph transport capacity, and hence the
development of lymphedema.
It was found that recurrent attaks of infections playa major
role in the production and exageration of lymphedema. Also, the
incidence, of lymphedema is increased, which may reach 47.5% if
radical mastectomy is accompanied with radiotherapy either pre- or
postoperatively. Other factors such as, obesity, age of the patients,
and hypertension may playa role in pathogenesis of postmastectomy
lymphedema. Recently, it was found that, the underlying lymphatic
abnormalities and inadequate lymphatic collaterals, which may be
present before radical mastectomy, is the predisposing factor for the
development of lymphedema postoperatively.
The complications of lymphedema after radical mastectomy
varies from recurrent attacks of cellulitis to lymphangiosarcoma,
_____________ Sumlllary and COltclIlS;OIl - 73-
which is a rare but lethal complication. Diagnosis 01”lymphedema IS
supported by clinical finding of swollen extremity, volume
displacements and circumferential measurements. TIll’ level of
obstruction can be identified by lymphangiography or by radioisotopic
scaning. Once lymphedema is established it is never
eradicated, so, the best method of its treatment is to prevent its
occurrence, several factors which may be helfpful in prevention of
lymphedema, this factors may be related to patients, surgery, or
radiotherapy.
The patients are adviced to avoid minimal injuries of the
affected limbs. The factors related to surgery and woud care include
avoidance of wound infections, and post-operative seroma formation.
Radiotherapy should not be accompanied with complete surgical
dissection of the axilla. It is believed that the treatment of
lymphedema is mainly conservative. The conservative treatment can
be divided into two main categories; pharmachological, and
mechanical or physical.
The surgical management of postmastectomy lymphedema is
limited, and can be divided into two main categories; the excisional
and the drainage operations.
Finally.. five main important points should be kept in mind:
o Lymphedema after radical mastectomy is a permanent, non
curable problem, once it is established it is never eradicated.
e The combination of radical mastectomy and radiotherapy increase
the incidence.
@) The infections playa major role in the etiology.
______________ Sumnrary and Conclusion - 74-
e The treatment of this problem is mainly conservative,
o No surgical operation can cure lymphedema, and recurrence is the
role after all surgical procedures.
Recommendations:
We recommend further study on lymphedema after
mastectomy and its relation to varies etiological factors, and try to
reach a satisfactory protocol in its treatment. Also, we recommend
further co-operation between surgeons, radiologists, and physio
therapeutists in facing this major problem.