General Surgery

What are the primary goals of the individuals who come to you seeking your skills as a surgeon?

The first is to find the best surgeon they can for their care. Your reputation is built on achieving consistently successful results. Those results reflect your skill, training, and dedication to helping your patients. You have incorporated minimally invasive techniques, and work diligently to reduce postoperative bruising and swelling in order to speed their recovery.

The second goal your patients want to achieve is a rapid return to everyday life with minimal restriction in their activities. Doctors with a reputation for exceptional recovery time are in a singular position among their peers.

Reducing Recovery Time from Surgery

Recovery time is reduced through the systematic application of Manual Lymphatic Drainage (MLD) to reduce swelling, followed by NeuroMuscular Therapy to rapidly restore tissue mobility and further reduce scarring as healing progresses.

Mobilizing your patient's lymphatic system through Manual Lymphatic Drainage (MLD) prior to surgery and during the early postoperative period provides significant reduction in swelling within the first few days of surgery. In addition, it provides the benefits of increased lymph circulation in the tissues, which include faster healing, reduced scaring, increased immune system response, and it prevents adhesions.

NeuroMuscular Therapy applied in the postoperative period reduces the muscular hypertonicity around joints that results in reduced range of motion.

Patients are thrilled with the rapid results and your skill is enhanced. I've been complementing mainstream medicine for over 30 years. Find out how I can help you enhance your reputation for exceptional recovery time.

Manual Lymphatic Drainage

MLD is proven to be effective for all surgery patients. It is especially effective for plastic surgery procedures such as facelifts, skin grafts, liposuction, body lifts, and reconstruction. Its benefits include:

• Reduced post operative edema
• Increased production of lymphocytes
• Reduced post operative risks
• Reduced need for heavy pain medication
• Improved appearance of skin grafts and improved tissue mobility at the source of the graft.
• Reduced contour irregularities associated with liposuction and tummy tucks
• Quicker return to normal life.
  

MLD provides optimal benefits when incorporated into your patient’s pre and post surgical regimens.

Pre-operatively – Between one or two treatments prior to surgery are recommended.  Ideally, your patient receives the final pre-op treatment the day before surgery. The resulting increase in lymphatic transport volume facilitates reabsorption of excess protein molecules, cellular debris, and waste products that may have accumulated in the interstitial spaces of your patient’s dermis due to fatigue, stress, infections, medications, alcohol consumption, smoking, lack of physical activity, or age.  By reducing the presence of large, hydrophilic protein molecules, and potential sources of inflammation, your patients experience less post surgical swelling and less opportunity for infection. MLD increases blood flow, oxygen and nutrients to the interstitium. In addition you will find it easier to make an incision in clean, well-drained tissue. [to read more]

Post-operatively – Three to five treatments are recommended, starting as soon as 24-hours after surgery. Trauma (surgery) results in the release of hormones into the system and depresses the function of the lymphatic system. MLD is used stimulate temporary rerouting of lymph to functional collectors and nodes to reduce swelling. The work achieves a wide variety of beneficial effects, the most significant being reduction in bruising and post surgical edema.

By reducing the time it takes to heal, the postoperative risks of surgery are reduced; your patients are thrilled, and you reap the benefits.

Manual Lymphatic Drainage

Manual Lymph Drainage (MLD) as developed by Emil and Estrid Vodder and published in 1936 was researched by Johannes Asdonkis on 20,000 patients at his clinic in 1967. Indications and contraindications were established based on this work. Manual Lymphatic Drainage is currently a standard practice of care in Europe.

MLD incorporates distinctive manual processes that utilize both a pressure and relaxation phase to redirect accumulated lymph to the nodes. If blockage is present due to surgical incisions and / or inadvertent removal of nodes during liposuction, the lymph is manually rerouted through the nearest anastamoses and towards uncompromised lymph nodes.

The technique uses the spongy part of flat hands and fingers to generate gentle, directionally specific wave-like movements. The movement gently stretches the skin to stimulate the natural peristalsis of the lymphatic collectors, while the slow rhythm functions to engage the parasympathetic nervous system. The resulting increase in lymph flow stimulates the production of lymphocytes increasing the body’s immune response.

Initial post surgical treatment works on the proximal side of the surgical site, away from scar in an area where sensitivity permits. The increased lymphatic flow from the nearby, unaffected tissues into the nodes, or into the subclavean veins, creates a capillary effect that draws lymph from the surgical area. As healing progresses, the work moves closer to the surgical area, again as sensitivity permits. Work near incisions is always performed with gloved hands.

Benefits of postoperative MLD treatments include:

• Reduce secondary edema and bruising.
• Prevent connective tissue adhesions and contour irregularities through the mechanical stretching / broadening of tissue
• Enhanced regeneration of tissue, including burns, wounds and wrinkles
• Reduced scarring by promoting lymphatic flow through the scar
• Reduced scarring through organization of the collagen fibers into finer, less visible scars and may prevent formation of keloids
• Reduced risk of bacterial infection due to high protein concentration.
• Stimulate immune response -- increased production of lymphocytes and immunoglobulins
• Reduced pain and spasm by activating the Parasympathetic Nervous System (PNS)
• Stimulates regeneration of lymphatic pathways.
• Promote “normal” range of motion
• Speed removal of medication and histamines
• Counteract the effect of immobilization in bed 
  

Regular MLD treatments also have an anti-aging effect, which will prolong the results of facelift surgery and add to your patient’s high esteem of your skill.

Lymphatic System Overview

What is the Lymphatic System?

The lymphatic system performs three main functions in your body.

1. Intestinal lymph vessels absorb fat-soluble vitamins.
2. Lymphocytes and lymph nodes respond to foreign cells, microbes, and cancer.
3. Transport of water, protein molecules, cell debris, and other large molecules from the spaces between the skin cells to the cardiovascular system where they are processed by the liver, kidneys, and spleen.
   

Lymph has two major functions in your body.

• It transports fluid, large protein molecules, and waste products of cellular metabolism. The lymph vessels drain skin, muscles and organs at three levels in the body.  The lymphatic system begins at the blood capillary level, where many chemical and mechanical reactions take place. 
• It is responsible for protecting the body from infection and disease through failure of the immune response system. 
  

Often described as a secondary circulatory system it circulates lymph throughout your body through a web of lymph capillaries, vessels, nodes, and glands, but without a heart to drive it.

• The cardiovascular system has a central pump (the heart) that moves blood throughout your body. The lymphatic system has no central pump; the lymph moves slowly and under low pressure due mostly to the intrinsic contractions of the muscles in the walls of the lymph collectors, the milking action of skeletal muscles, and one-way valves.
• The cardiovascular system brings nutrients and oxygen to the interstitial spaces through the migration of plasma (the liquid part of blood) through the capillary walls. Cells take up the nutrients and oxygen, and release waste products back into the interstitial spaces. The lymphatic system collects lymph (formerly plasma) that did not migrate back across the capillary walls into the blood stream, large molecule proteins, and the cellular waste products too large to move through the capillary walls.
• The cardiovascular system is “closed” meaning the blood flows out of your heart and back again through a series of vessels and capillaries. The lymphatic system is “open” meaning it originates from the spaces between your tissue cells and moves fluid through a “parallel” series of capillaries and vessels that direct it through your lymph nodes on its return path to your cardiovascular system.
• The cardiovascular system is “delivery and return” while the lymphatic system is “return only.”

What is Lymph?

Lymph is most often seen as a clear, yellowish fluid that seeps from blisters, burns, and insect bites that have been scratched. It originates as blood plasma that has moved out of the capillaries and into the interstitial spaces, bringing nutrients and oxygen to your cells. The blood capillary system reabsorbs all but about 10% of this plasma. The function of the lymphatic system is to collect this remaining fluid, which becomes “lymph” when it is taken into the lymphatic capillaries. Lymph has almost the same composition as the original interstitial fluid.

Why is the lymphatic system important to my surgery?

Your lymphatic system responds to surgery as it would an injury. It is responsible for providing an immune response, and for facilitating healing. However, its initial response to injury is a reduction in performance. This means the hormones released in response to your surgery, and the proteins in the blood remain in your tissues rather than being swept away as lymph bathes the area. The result is bruising, and swelling as the protein molecules absorb water.

Manual Lymphatic Drainage treatments can make a significant difference in your post surgery appearance, and how rapidly you heal.

• Before surgery, your lymphatic drainage treatments increase the volume of lymph moving through your tissues. This “flushing” process provides a significant reduction of waste products (toxins) in the interstitial spaces of your skin along with an increase in nutrients and oxygen. Your tissues will be well hydrated and nourished, in their best possible condition for your surgery.
• After surgery, the total volume of lymph your system can move will be reduced, or even stopped, due to the surgical trauma, anesthesia, pain medications, etc. Left unchecked, cellular function and healing is significantly compromised resulting in swelling and bruising that is slow to resolve. Your lymphatic drainage treatments, (starting as soon as 24-hours after surgery with your physician’s permission) stimulate the movement of lymph by rerouting the accumulated fluid through alternative paths unaffected by your surgery. The benefits cannot be understated:
• Rapid and significant reduction in swelling, bruising, and pain.
• Stimulates your immune system, which helps prevent post-surgical infection.
• Improves skin regeneration and healing.
• Optimizes the scarring process and may reduce or prevent keloid formation.
• Continued treatments are beneficial for aging skin and aid in maintaining the long-term effects of your cosmetic surgery. 

Does Lymphatic Drainage have any other uses or benefits?

It has been shown to improve symptoms related to:

• fibromyalgia,
• chronic fatigue,
• sinus and migraine headaches,
• reflex sympathetic dystrophy,
• inflammatory rheumatism,
• scleroderma,
• de-toxifying the skin,
• Fibrocystic breast disease
• Pain control
• Accelerated healing of sprains, torn ligaments, and broken bones.
  

Today lymph drainage therapy is employed as standard scientific practice throughout Europe and continues to gain recognition in the United States.

Diane Hovey, PhD -- Improving Recovery, Enhancing Reputations [contact Diane]