Pedro Ciudad1,2, Oscar J Manrique3, Samyd S Bustos3, Mouchammed Agko4, Tony Chieh-Ting Huang3, Luis Vizcarra2, Marco Lazo Nuñez5, Federico Lo Torto6, Antonio J Forte7. 1. Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru. 2. Institute of Plastic, Reconstructive and Aesthetic Surgery, Ciruesthetic, Clinic, Lima, Peru. 3. Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA. 4. Section of Plastic Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA. 5. National Institute of Child Health-Breña, Lima, Peru. 6. Department of Surgery "Pietro Valdoni", Plastic Surgery Unit, Sapienza University of Rome, Rome, Italy. 7. Department of Plastic and Reconstructive Surgery, Mayo Clinic, FL, USA.
Abstract
BACKGROUND: A paradigm shift towards the use of combined physiological and excisional surgical approaches for the treatment of lymphedema is permeating the surgical practice worldwide. We describe a single-stage surgical approach combining-vaser assisted liposuction (VAL) and lymphatico-venous anastomoses (LVA) for the treatment of extremity-lymphedema. METHODS: Between March 2018 and March 2019, a retrospective review of patients with extremity-lymphedema stage IIb-III International Society of Lymphology who underwent the combined technique was done. Demographics, operative characteristics, clinical outcomes and complications were assessed. Additionally, a systematic review of studies that reported combined physiological procedures with liposuction for the treatment of lymphedema was conducted. RESULTS: A total of 24 patients [12 upper extremity lymphedema (UEL), and 12 lower extremity lymphedema (LEL)] were included and analyzed. The mean age was 54.5 years (38-72 years). The mean circumference reduction rate was 90% and 85% for UEL and LEL, respectively. Infection rate decreased to zero postoperatively in all patients. Ten studies were included in the review: six pooling 220 cases included two-stage procedures, and four pooling 66 cases described one-stage surgeries. All patients who underwent a combined approach reported clinical improvement. CONCLUSIONS: Our combined approach is safe surgical option and allows adequate limb size reduction with faster recovery in selected patients with lymphedema with strong fibroadipose component. 2020 Gland Surgery. All rights reserved.
BACKGROUND: A paradigm shift towards the use of combined physiological and excisional surgical approaches for the treatment of lymphedema is permeating the surgical practice worldwide. We describe a single-stage surgical approach combining-vaser assisted liposuction (VAL) and lymphatico-venous anastomoses (LVA) for the treatment of extremity-lymphedema. METHODS: Between March 2018 and March 2019, a retrospective review of patients with extremity-lymphedema stage IIb-III International Society of Lymphology who underwent the combined technique was done. Demographics, operative characteristics, clinical outcomes and complications were assessed. Additionally, a systematic review of studies that reported combined physiological procedures with liposuction for the treatment of lymphedema was conducted. RESULTS: A total of 24 patients [12 upper extremity lymphedema (UEL), and 12 lower extremity lymphedema (LEL)] were included and analyzed. The mean age was 54.5 years (38-72 years). The mean circumference reduction rate was 90% and 85% for UEL and LEL, respectively. Infection rate decreased to zero postoperatively in all patients. Ten studies were included in the review: six pooling 220 cases included two-stage procedures, and four pooling 66 cases described one-stage surgeries. All patients who underwent a combined approach reported clinical improvement. CONCLUSIONS: Our combined approach is safe surgical option and allows adequate limb size reduction with faster recovery in selected patients with lymphedema with strong fibroadipose component. 2020 Gland Surgery. All rights reserved.
Entities:
Keywords:
Lymphedema; breast cancer lymphedema; lymphatico-venous anastomoses (LVA); suction-assisted lipectomy (SAL)
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