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Treatment of lower extremity lymphedema with suction-assisted lipectomy.

Lymphedema is characterized by the early accumulation of high protein fluid in the skin and subcutaneous tissue, followed by chronic deposition of fat and fibrous tissue. Lymphedema is a common disease, affecting approximately 140 million people throughout the world.1 Primary, idiopathic lymphedema can occur at birth (Milroy disease), puberty (praecox), or adulthood (tarda). Secondary lymphedema, caused by an inciting event, is most commonly due to the parasite Wuchereria bancrofti or to iatrogenic damage. In Western countries, for example, lymphedema occurs in up to 38 percent of breast cancer patients because of axillary lymph node dissection or radiation.2 Presently, no cure exists for lymphedema. Medical management consists of compressive garments and regimens. Surgical intervention is reserved for patients with significant morbidity (e.g., recurrent cellulitis or functional impairment) who have failed conservative therapy. Surgical treatment can either reestablish lymphatic connections (physiologic procedures) or remove tissue (excisional procedures). Physiologic procedures have met with little success, whereas excisional procedures are susceptible to recurrence and complications. Currently, the most commonly performed operation for lymphedema is staged subcutaneous resection. Subcutaneous excision, however, requires multiple stages; it is technically challenging and is associated with recurrence, infection, thromboembolism, extensive cutaneous scarring, and wound dehiscence. To reduce the morbidity of staged subcutaneous excision, suction-assisted lipectomy recently has been utilized to reduce the volume of upper extremity lymphedema after breast cancer.3 Liposuction is less invasive than other surgical procedures for lymphedema; it has been associated with minimal morbidity and has achieved complete edema reduction in conjunction with compression garments with 4 years of follow-up.4 The authors hypothesized that the success of treating upper extremity lymphedema using suctionassisted lipectomy could be translated to patients with lower extremity lymphedema. Consequently, liposuction was used to treat a patient with significant bilateral lower extremity lymphedema who refused amputation and failed conservative management. Eighteen months after a one-stage liposuction procedure, her edema and morbidity have significantly improved.