Pengobatan LimfedemaTanpa Memerlukan Operasi

(Conservative Treatment Of Lymphedema WithoutSurgery)

Prof Dr Hendro Sudjono Yuwono,drFK-Unpad/RSHS

It is no cure for lymphedema,Conservative treatment for

Better Quality of life

DEC

Plasmodium,Dengue,Cikugunya

Limfedema (-)

Limfedema (+)

= Filariasis

Memutus Rantai Penularan Filariasisadalah dengan memperbaiki

Sanitasi personal dan Sanitasi lingkungan

Mosquitto ControlKeuntungan : Memberantas

penyakit lainnya yangdisebabkan vektor nyamuk

Sanitasi Personal

SanitasiLingkungan

3M

FilariasisDengue,Malaria,Cikungunya

Why not do surgeryon lymphedema ?

Anastomosis only in 3lymph vessels ( 6hours operation).

Whether it can replacehundreds ofvessels areclogged ???

Hanya 3 pembuluhlimfe yangdianastomosiskan (6jam operasi ).Apakah dapatmenggantikanratusan pembuluhyang tersumbat ???

Many lymphaticobstruction in theproximaloperation-site,reduction will notsucceed inlymphedema.

Obstruksi pembuluh limfe dankelenjar sudah terjadi di bagianproksimal dari daerah operasi

Daerah operasi biasanyadibawah lutut

Bila operasi dilakukan dalam situasiklinik seperti ini penyembuhan lukayang lama penyembuhan lukaterganggu oleh cairan protein yangmembanjiri daerah luka.

Postoperative Tissue Reduction SurgeryPostoperative Tissue Reduction Surgery

Lymphoedema increases, worsening cosmetics

Incisionscar

Incisionscar

A

RSUPDr HasanSadikin

BandungHospital :Terapi DietVegetarian Smaller in

4 months

Adelaide, AustraliaJohn &Judith R. Casley-Smith dan Neil Piller

DEC Tidak dapat mengobati Kaki Gajah,

karena:1.Mikrofilaria tidak ditemukan lagi pada penderita KakiGajah !!2.Bila masih ada mikrofilaria dalam darah dan berhasildibunuh oleh DEC, keadaan penyakit Kaki Gajah-nya tidakakan berkurang dengan matinya Filaria.3.Mikrofilaria dapat masuk tubuh penderita yang sudahbersih dari Filaria (re-infection).

+ Microfilaria

DEC

DEC is not able to treat elephantiasis, because:

1. Microfilariae no longer found in patients with elephantiasis!

1. If there were microfilariae in the blood and was killed by theDEC, the state of his elephantiasis will not be diminished bythe death of Filaria.

1. Microfilariae can enter the patient's body that is clean ofFilaria (re-infection).

Terapi Non-operasi

• Diet Vegetarian

• Obat-obatan Benzopyrones

• Physiotherapy: Lymphapress,pembalut elastis dari distal keproximal, senam

• Terapi untuk kulit.

Sumber MCT: makanan nabati.MCT dicerna dihepar, dan tidak masukkedalam cairan limfe.

Non-MCT dicerna didalam usus,kemudian masuk menjadi komponencairan limfehipertensilimfatikextravasatedproteinfibrosissumbatanlimfatik>>.

MCT=Medium-Chained Triglyceride

MCT sources: plant-based foods.Liver: MCT ingested, and not going intothe lymph fluid.Non-MCT (meat) is digested in theintestine, then going into the lymph fluidcomponent extravasated proteininflammationFibrosiscausing manymore lymphatic channels obstruction.

MCT = Medium-Chained Triglycerides?

Role of Vegetarian Diet inovercoming Lymphedema

The Role ofExtravasated Protein

Hipertensi limfeOccludedLymphatic vessel

Hypertensivelymphatic

Extravasatedprotein

Inflammation

Fibrosis

More occludedlymphatic channel

More edema