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Liposuction normalizes elephantiasis of the leg - a prospective study with an eight-year follow-up.
Hakan Brorson, M.D., Ph.D..
Department of Plastic and Reconstructive Surgery, Lund University, Skane University Hospital, Malmo, Sweden.

PURPOSE:
Patients with long-standing pronounced non-pitting lymphedema do not respond to conservative treatment or microsurgical procedures (such as lympho-venous shunts, lymph vessel transplantation or lymph node transfer) because slow or absent lymph flow, as well as chronic inflammation, cause the formation of excess subcutaneous adipose tissue which cannot be removed by these methods. Previous surgical techniques utilizing either total excision with skin grafting or reduction seldom achieved acceptable, cosmetic and functional results. The swelling of chronic non-pitting arm lymphedema following breast cancer, can be completely reduced by liposuction and has not recurred during more than seventeen years’ follow-up. Encouraged by this experience, we decided to test the effectiveness of liposuction on leg lymphedema.
METHODS:
41 patients with an age of 52 years (range, 17-76) and a duration of leg swelling of 15 years (range, 2-50) underwent liposuction due to non-pitting, chronic lymphedema (Figure 1). There were 19 primary (PL), and 22 secondary lymphedemas (SL) following cancer therapy. Age at cancer treatment and interval between cancer treatment and lymphedema start were 42 years (range, 20-64), and 3 years (range, 0-26) respectively. Age at onset of PL was 29 years (range, 4-55). All patients had received conservative treatment before surgery without further reduction. All were wearing compression garments before surgery. Aspirate and leg volumes were recorded.
RESULTS:
Aspirate volume was 4116 ml (range, 1200-7330) with an adipose tissue concentration of 94% (range, 61-100). Preoperative excess volume was 4195 ml (range, 1210-8475). Postoperative mean reduction was 84% (range, 43-135) at 3 months and 105% (range, 75-163) at 1 year, and more than 100% during 8 years’ follow-up when it was 133% (range, 123-142), i.e. the lymphedematous leg was somewhat smaller than the healthy one (Figure 2). The preoperative mean ratio between the volumes of the edematous and healthy legs was 1.4, rapidly declining to 1.0 at 6 months, and less than 1 after one year.
CONCLUSION:
Liposuction is an effective method for treatment of chronic, non-pitting leg lymphedema in patients who have failed conservative treatment. It is the only known method that completely reduces excess volume. The removal of hypertrophied adipose tissue is a prerequisite to complete reduction. The reduced volume is maintained through constant use of compression garments postoperatively.


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