Liposuction With Simultaneous Contouring Skin Excision For Advanced Solid-Predominant Limb Lymphedema
Wei F. Chen, MD, Jonathan Lensing, M.D., Mindy Bowen, R.N..
University of Iowa, Iowa City, IA, USA.
PURPOSE: Liposuction is an effective treatment for advanced extremity lymphedema. The skin excess created following bulk reduction is classically left behind due to wound healing concern. Having consistently experienced unsatisfactory results with the classical approach, we began performing lymphedema liposuction with simultaneous contouring skin excision (LLSCSE). We describe our 5-year experience of LLSCESE.
METHODS: Standard tumescent liposuction under tourniquet control was performed for affected arms, legs, or thighs. Liposuction concluded upon achieving 1 - 1.5 cm of subcutaneous fat. Following liposuction, skin excision was immediately performed. No drain was placed. 30-40 mmHg compression was applied. All cases performed between February 2014 to January 2019 were included. Patient selection was based on indocyanine green (ICG) lymphography and MRI findings showing solid-predominant lymphedema. Outcomes assessed were volume reduction, postoperative complications, lymphedema QOL scale, and postoperative ICG lymphography.
RESULTS: 89 LLSCSE cases were performed. Disease severity were Campisi III - V. Mean follow-up was 29 months (8 - 56). Mean volume reduction were 1297, 2552, 3984 cc from arm, leg, and thigh, respectively. 11 patients (12.3%) developed minor wound dehiscence. 4 (4.5%) experienced skin necrosis. None had hematoma. All demonstrated improvement on QOL scale. Interestingly, 81 (91%) showed paradoxical improvement in lymphatic drainage on ICG lymphography.
CONCLUSION: LLSCSE demonstrated favorable surgical outcome. It is a viable alternative to the classical technique.
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