A team headed by Dr. Nilesh Satbhai, Consultant Plastic and Reconstructive Microsurgeon, Bai Jerbai Wadia Hospital For Children successfully treated a 17-year-old boy with Primary Lymphoedema. The boy who had massive swelling over the entire lower limbs and was bed-ridden can move freely now.
Puraw Vira, a resident of Mumbai started developing swelling over both his feet and ankles when he was 8. His parents consulted several doctors, but could not find any solution to his problem. This swelling gradually progressed to the legs, thighs, and later the groin as well. He couldn’t do his daily activity with ease. With time and the legs progressively became very bulky and heavy. The child would develop intermittent infections over the legs requiring repeated hospital admissions. He was bed-ridden in April 2021, for over a month and his basic activities were restricted to a major extent and required assistance from his family members. The patient was referred to the Plastic Surgery department at Bai Jerbai Wadia Hospital for Children wherein he could stand on his feet again after prompt treatment.
Dr. Nilesh Satbhai, Consultant Plastic, and Reconstructive Microsurgeon said, “The patient presented at the hospital with a history of swelling in both lower limbs and groin, and was bed-ridden. He was diagnosed to have primary lymphoedema, commonly known as elephantiasis. It is a clinical diagnosis. Tests like lymphoscintigraphy help in assessing the problem and planning treatment. Primary lymphedema is rare, affecting 1 in 100,000 individuals. Secondary lymphedema is the most common cause of the disease and affects approximately 1 in 1000 individuals.”
Lymphoedema is a chronic condition that causes swelling in the body tissues. It can affect any part of the body but usually develops in the arms or legs. It develops when the lymphatic system does not work properly and the patient becomes immobile and is left untreated.
Dr. Satbhai added, “Puraw was advised to undergo surgery for the treatment of lymphedema. After optimal preoperative preparation, he underwent vascularized lymph node transfers (VLNT) for both the lower limbs. VLNT is an advanced microvascular procedure, in which a few normal lymph nodes are taken from a distant part and they are implanted into the limb affected by lymphedema. These transferred lymph nodes then help to drain the excess fluid from the limb and reduce the limb swelling. The surgery lasted for 6 hours and the boy was discharged after 10 days. He recovered well after the microvascular surgery on both lower limbs and the swelling on both his legs reduced significantly. The surgery has helped the boy to become mobile, playful, and active again. The parents are advised to perform a special type of massage called ‘manual lymphatic drainage.”
“Currently, advanced microvascular surgery (vascularized lymph node transfer) is being performed at very few centres in the country, and the Bai Jerbai Wadia Hospital for Children is one of them. It has shown good results and is a big hope for these patients who had no better solution till now,” said Dr. Minnie Bodhanwala, CEO Of Wadia Hospital.
“Now, Puraw weighs 44 kgs and goes to school as the swelling has gone. His class is on the second floor and he climbs stairs without any help,” concluded Puraw’s mother Jigna Parin Vira.