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, 7 (11), e2513
eCollection

Lymphedema Liposuction With Immediate Limb Contouring

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Lymphedema Liposuction With Immediate Limb Contouring

Wei F Chen et al. Plast Reconstr Surg Glob Open.

Abstract

Liposuction is the treatment of choice for solid predominant extremity lymphedema. The classic lymphedema liposuction technique does not remove skin excess created following bulk removal. The skin excess is presumed to resolve with spontaneous skin contracture. We investigated the technique of simultaneously performing liposuction with immediate skin excision in patients with solid predominant lymphedema and compared the outcome with that from the classic technique.

Methods: Modified liposuction with skin excision (mLIPO) and standard liposuction without skin excision (sLIPO) were offered to patients with solid predominant extremity lymphedema. Skin traction of 4 cm and undulating skin mobility constituted positive "flying squirrel" sign. Patients with negative "flying squirrel" sign were excluded. mLIPO patients underwent skin excision. Surgical outcomes and postoperative complications were compared.

Results: The study enrolled 15 and 26 patients into the sLIPO and mLIPO groups, respectively. mLIPO patients demonstrated statistically significant decrease in seroma/hematoma, contour irregularity, and skin necrosis, while experiencing increased procedural satisfaction.

Conclusions: Skin excision following liposuction for solid predominant lymphedema is safe. It decreases postoperative complication and improves surgical outcome.

Figures

Fig. 1.
Fig. 1.
Bioimpedance spectroscopy in this patient with solid predominant left arm lymphedema showed an interarm body water discrepancy of only 0.32 L (2.96–2.64 L). This amount of discrepancy does not sufficiently explain the observed left arm bulk.
Fig. 2.
Fig. 2.
An abundance of adiposity can be seen in this patient with solid predominant leg lymphedema. Although there is also significant subcutaneous edema (grey area), it contributes relatively less to the overall bulk of the leg.
Fig. 3.
Fig. 3.
Despite having ISL stage III disease, this patient demonstrated relatively mild cutaneous fibrosis. In authors’ experience, the degree of cutaneous fibrosis correlates well with the severity of subcutaneous fibrosis. Liposuction remains an effective debulking method for this patient. ISL, International Society of Lymphology.
Fig. 4.
Fig. 4.
Contour irregularity and skin necrosis seen in an sLIPO patient. A, This patient had bioimpedance spectroscopy and MRI suggestive of solid predominant disease. B, On postoperative day 3 following sLIPO, multiple areas of skin ischemia were observed. C, Skin necrosis and contour irregularity seen at a month postoperatively. D, Despite the complications, the patient was happy with the surgical outcome. MRI, magnetic resonance imaging.
Fig. 5.
Fig. 5.
An mLIPO patient with left leg lymphedema preoperatively (A) and at a month postoperatively (B). Her postoperative course was uneventful. The skin excess was excised from the medial aspect of the leg. No contour irregularity was observed. She was happy with the surgical outcome.
Fig. 6.
Fig. 6.
An mLIPO patient with right arm lymphedema preoperatively (A, B) and at 3-month postoperatively (C, D). Skin excision was necessary both from the forearm and the upper arm due to demonstrating positive FSS at both segments. She healed uneventfully. Mild contour irregularity was seen at the elbow and the wrist, secondary to residual skin excess. She was happy with the surgical outcome.
Fig. 7.
Fig. 7.
Large amount of skin excess predisposed to skin folding when external compression was applied, resulting in ischemic necrosis.
Fig. 8.
Fig. 8.
An mLIPO patient with right arm lymphedema preoperative (A) and at 3 months postoperatively (B). As many of our patients had elevated BMIs, the treated limb frequently became smaller than the contralateral healthy limb, making the contralateral limb an inappropriate template for preoperative garment preparation. BMI, body mass index.

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