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LIPOSUCTION OF LOWER LIMB WITH PITTING LYMPHEDEMA - CASE REPORT
Department of Surgery, Prague, Czech Republic
WALD M.
Introduction: Conservative treatment is not successful in some patients with lower limb lymphedema despite all efforts and significant fluid retention persists in the epifascial area particularly in the lower leg and around the ankle and foot – pitting lymphedema – contributing to the increased volume of the lower limb.
Materials & Methods: A case of a 70 year old woman with primary lymphedema of both lower limbs with progressive impairment of swelling of both legs and pronounced increase of volume in the area of lower leg, around the ankles and in the area of feet in the last 14 years is presented. There are early signs of fibrosis on the skin and subcutaneously. Because the long-term conservative treatment failed and patient’s quality of life was significantly limited due to the volume and the heaviness of the lower limbs, liposuction was performed on the right lower limb even though it was a pitting lymphedema. Totally 5.500 ml was sucked up with adipose tissue: fluid ratio = 1:3. The postoperative course was uneventful.
Conclusion: Three months postoperatively, the volume of the surgically treated limb was 4.638 ml less than before the surgery (19.010 ml versus 14.372 ml). The epifascial soft tissues show markedly less fibrotic remodelling and the trophic skin condition improved. Theoretical presumptions of the soft tissues improvement in terms of both, their volume and quality are discussed in the lecture.
QUALITY OF LIFE AFTER LYMPHEDEMA SURGERY WITH LYMPHOVENOUS ANASTOMOSIS (LVA) IN SUPERMICROSURGERY TECHNIQUE
SEIDENSTUECKER K. 1, MUNDER B. 2, ANDREE C. 2, ZEL TZER A. 1, HAMDI M. 1
1 University Hospital Brussel, Department of Plastic Surgery, Brussels, Belgium 2 Department of Plastic Surgery, Hospital Duesseldorf, Germany
Introduction: Previous authors showed that lymphedema impacts the Health related Quality of life in many dimensions. This study regards the improvement of the quality of life from patient suffering from lymphedema after the operative treatment with lymphatic venous anastomosis (LVA).
Material and Methods: From 2011 to the end of 2013 we have operated on 15 lymphedema patients. Of these, 2 involved the lower limbs and the rest were in the upper limb. Most of the patients had developed lymphedema as a result of axillary dissection for treatment of breast cancer. Various procedures have been attempted for draining lymph fluid into other lymphatic basins or into venous ciruculation. We performed lymphatic -venous anastomosis (LVA) in supermicrosurgery technique on the affected limb.
To compound error in measurements to different dates with or without additional lymphatic manual compression therapy, we decided to evaluate the quality of life with a standardised questionnaire.
This questionnaire has two parts – first regarding the time before the lymphatic surgery and the second for the time after. It looks at three aspects of quality of life: physical health and constitution, mental health and social adverse effects and lastly adverse effects caused by the conservative therapy.
Results: In the first part related to the physical adverse effects before the operation was the average numbers 55% related to 100% best possible quality of life. After the operation the quality of life raise to 71%. So the relative improvement of the quality of life was 29%. Regarding the mental health and social adverse accounted 27% relative improvement from pre- to postoperative.
Finally the adverse effects caused by the conservative therapy about compression garments and the frequency of manual lymphatic drainage the patients stated preoperative only 11% related to 100% possible quality of life. The 11% raised to 46% postoperative. The relative improvement is here more than 300%.
Conclusions: Lymphatic venous anastomosis is a promising procedure that increase the quality of life. Particularly it influence the adverse effects caused by the conservative therapy.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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