Liposuction as a Viable Treatment for End-Stage Upper Extremity Lymphedema



Liposuction as a Viable Treatment for End-Stage Upper Extremity Lymphedema


Jaume Masià

Cristhian D. Pomata

Patrícia Martínez-Jaimez





Indications

A surgical approach to remove the hypertrophied fibroadipose tissue is suitable when a complete reduction of the excess volume of the arm has not been achieved by
conservative treatment or microsurgical lymphatic procedures. The main indication for selective liposuction as the treatment of upper extremity lymphedema is the presence of nonpitting lymphedema. Nevertheless, every patient is rigorously independently evaluated based on the clinical examination of the lymphedema stage according to the International Society of Lymphedema (ISL) (Table 32-1) (18), and the results of the preoperative indocyanine green (ICG) lymphography assessment (19). There are two predominant circumstances:



  • Primary selective liposuction is indicated in cases of volume excess, nonpitting lymphedema ISL stage III, and nonfunctioning lymphatic channels by ICG lymphography assessment.


  • Secondary selective liposuction is indicated in cases of volume excess, nonpitting lymphedema in late ISL stage II, and functioning lymphatic system by ICG lymphography assessment; in patients with previous microsurgical lymphatics’ derivation, reconstruction, or transplantation techniques.








TABLE 32-1 Staging of Lymphedema of the International Society of Lymphology

















ISL Stage Features
0/IA Latent or subclinical condition where swelling is not yet evident despite impaired lymph transport.
I Early accumulation of fluid relatively high in protein content which subsides with limb elevation. Pitting may occur.
II Limb elevation alone rarely reduces the tissue swelling and pitting is manifest. In late stage II, the limb may not pit as excess subcutaneous fat and fibrosis develop.
III Lymphostatic elephantiasis where pitting can be absent and trophic skin changes such as acanthosis, alteration in skin character and thickness, further deposition of fat and fibrosis, and warty overgrowths have developed.

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Aug 25, 2021 | Posted by in Aesthetic plastic surgery | Comments Off on Liposuction as a Viable Treatment for End-Stage Upper Extremity Lymphedema

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