A 28-year Single Institutional Experience of Complete Reduction of Extremity Lymphedema Using Suction Assisted Lipectomy.

PURPOSE: Absent lymph flow and chronic inflammationleads to excess subcutaneous adipose tissue deposition.Chronic non-pitting lymphedema does not respond to conservativetreatment or microsurgical procedures becausethey do not target the adipose tissue. Removing the adiposetissue using suction assisted lipectomy (SAL) seems thus tobe a logic treatment strategy.METHODS: Arms: 190 women, mean±SEM age of 62±0.8years, with a duration of arm swelling of 8.6±0.5 yearsunderwent SAL. Age at breast cancer operation, intervalbetween breast cancer operation and lymphedema start, andduration of lymphedema were 51±0.8 years, 2.8±0.4 years,and 8.6±0.5 years respectively. Legs: 128 patients with amean age of 49±1.4 years and with a duration of leg swellingof 13±0.9 years underwent SAL. There were 64 primary(PL) and 64 secondary lymphedemas (SL) following cancertherapy. Age at cancer treatment and interval between cancertreatment and lymphedema start were 2.5±0.7 years and42±1.7 years respectively. Age at onset of PL was 10 years.RESULTS: Arms: Preoperative mean excess volume was1404±52 ml. Postoperative reduction was 104±2.0% at 3months and 117±2.1% at 1 year, and more than 100% during28 years’ follow-up. Legs: Preoperative excess volumewas 3580±153 ml. Postoperative reduction was 82%±2.3%at 3 months and 101±2.3% at 1 year, and more than 100%during 23 years’ follow-up.CONCLUSION: SAL is effective for treatment of chroniclymphedema in patients who do not respond to conservativetreatment. Removal of the hypertrophied adipose tissueleads to complete reduction. Constant use of compressiongarments maintains outcome

Liposuction Normalizes - in Contrast to Other Therapies - Lymphedema-Induced Adipose Tissue Hypertrophy

The various types of treatment of lymphedema are under discussion and there has been some controversy regarding liposuction for lymphedema. Although it is clear that conservative therapies such as complex decongestive therapy (CDT) and controlled compression therapy (CCT) should be tried in the first instance, options for the treatment of late-stage lymphedema that is not responding to such treatment is not so clear. Improvements in technique, patient preparation, and patient follow-up have led to a greater and a wider acceptance of liposuction as a treatment for lymphedema. This paper outlines the benefits of using liposuction and presents the evidence to support its use

Liposuction and Controlled Compression Therapy in the Treatment of Arm Lymphedema following Breast Cancer

Liposuction and controlled compression therapy in the treatment of arm lymphedema following breast cancer About one-third of all women treated for breast cancer develop arm lymphedema. The cancer itself is a worry, but the swollen and heavy arm is an additional handicap for the patients, both physical and psychosocial. Previous surgical and conservative treatments have not always given satisfactory and permanent results, conceivably because lymphedema causes hypertrophy of the subcutaneous adipose tissue. From this point of view, liposuction (LS) combined with Controlled Compression Therapy (CCT) is an interesting approach as the hypertrophied adipose tissue is effectively removed and the outcome sustained by wearing a compression garment. Altogether 51 women participated in the present investigations. All, except one had received radiotherapy after the breast cancer operation which included the excision of axillary lymphnodes in all cases. Thirty-six patients were treated with LS and postoperative CCT, whereas 15 received CCT only. Pre- and postoperative arm edema volumes were measured using water displacement technique. Skin blood flow was recorded using laser Doppler imaging. Lymph transport in the arm was assessed with indirect lymphoscintigraphy. Rage of motion in the shoulder joint was measured using a protractor. Effects on quality of life were estimated using the Visual Analogue Scale, Nottingham Health Profile, Psychological General Well-Being index, and the Hospital Anxiety Depression scale. Results were monitored for up to one year after treatment. LS+CCT reduced the arm edema volume completely, compared with a 50% decrease following CCT alone. The use of a compression garment after liposuction is necessary to maintain the normalized arm volume. LS+CCT did not affect the already impaired lymph transport; it merely increased skin microcirculation. A reduced incidence of cellulitis was noted. The treatment improved range of motion in the shoulder joint and patients' quality of life, particularly qualities directly related to the volume reduction and thereby qualities associated with everyday activities. As could be expected from the volume measurements, the more favorable outcomes were recorded mostly in the LS+CCT group

Standardised measurements used to order compression garments can be used to calculate arm volumes to evaluate lymphoedema treatment.

Abstract Lymphoedema treatment outcome can be evaluated by calculating estimated limb volumes directly by water displacement (plethysmography; PG), or indirectly by circumference measurements (CM) and using the formula for a truncated cone. This study assessed the correlation between PG and circumference volume measurements to assess whether the correlation is acceptable, and if circumference measurements can be used to accurately assess arm volume. Ten women with unilateral lymphoedema after breast cancer treatment with a mean age of 66 (range 50-83) years volunteered for arm volume estimates by PG and circumference measurements. The coefficient of variation (CV%) for all methods was calculated. Two Excel-based formulae of the truncated cone were developed; one for fixed 4-cm intervals leading to 10 volume segments (CM-10-VS), and one for varying intervals leading to four volume segments (CM-4-VS). The CV% was 0.609% for PG, 0.628% for CM-10-VS, and 0.632% for CM-4-VS. As expected, PG generated a significantly larger volume of both arms because it includes the hand. The difference between CM-10-VS and CM-4-VS measurements was not significant. All three measurement methods showed a high coefficient of correlation (0.813-0.915), and a high coefficient of regression (0.863-1.089). The excess volume, which is used to determine treatment outcome, showed the respective values of 0.932-0.978 and 0.963-1.020, respectively. Using circumference measurements identical to those used when ordering made-to-measure compression garments speeds up volume measurements and can be used safely to evaluate lymphoedema treatment outcome

Development of a pressure-measuring device to optimize compression treatment of lymphedema and evaluation of change in garment pressure with simulated wear and tear.

The use of compression garments in treating lymphedema following treatment of genital (penis, testes, uterus, cervical) and breast cancer treatment is a well-established practice. Although compression garments are classified in compression classes, little is known about the actual subgarment pressure exerted along the extremity. The aims of this study were to establish an in vitro method for measuring subgarment pressure along the extremity and to analyze initial and over time subgarment pressure of compression garments from three manufacturers. The measurements were performed with I-scan(®) (Tekscan Inc.) pressure measuring equipment once a week during a period of 4 weeks. Wear and tear was simulated by washing and putting on the garments on plastic legs every day. There was a statistically significant difference between the garments of some of manufacturers. There was no difference between garments from the same manufacturer. No significant decrease of subgarment pressure was observed during the trial period. The study demonstrated that Tekscan pressure-measuring equipment could measure subgarment pressure in vitro. The results may indicate that there was a difference in subgarment pressure exerted by garments from different manufacturers and that there was no clear decrease in subgarment pressure during the first four weeks of usage

Histology of adipose tissue inflammation in Dercum's disease, obesity and normal weight controls: a case control study

<p>Abstract</p> <p>Background</p> <p>Dercum's disease (DD) is characterised by obesity and chronic pain (> 3 months) in the adipose tissue. The pathogenesis of DD is unknown, but inflammatory components have been proposed. In previous reports and studies, an inconsistent picture of the histological appearance of the adipose tissue in DD has been described. The aim of this investigation was to examine the histological appearance of adipose tissue in patients with DD, with particular focus on inflammatory signs.</p> <p>Methods</p> <p>Fat biopsies were sampled from painful regions from 53 patients with DD. In 28 of the patients, a control adipose tissue biopsy was taken from a location where the patient did not experience any pain. In addition, fat biopsies were sampled from 41 healthy pain-free obese control patients and 11 healthy pain-free normal weight control patients. The extent of inflammation was evaluated on histological sections stained with haematoxylin-eosin.</p> <p>Results</p> <p>There was no statistically significant difference in the extent of inflammation between the biopsies from the painful knee and the biopsies from the non-painful area (p = 0.5), nor between the biopsies from the abdomen, and the biopsies from the non-painful area (p = 0.4), in patients with DD. A statistically significant difference in extent of inflammation was observed between DD and obese control patients regarding the abdomen (p = 0.022), but not the knee (p = 0.33). There were no differences in extent of inflammation between DD patients and normal weight controls (p = 0.81).</p> <p>Conclusion</p> <p>The findings suggest that there is an inflammatory response in the adipose tissue in DD. However, this response is not more pronounced than that in healthy obese controls. This contradicts inflammation as the aetiology of DD.</p