RESUMO
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.
RESUMO
Lymphedema refers to the accumulation of protein-rich fluid in the interstitial spaces. This can occur secondary to congenital malformation of the lymphatic channels or nodes or as a result of an insult that damages appropriately formed channels and nodes. Stagnant, protein-rich lymph initiates an inflammatory response that leads to adipocyte proliferation, fibrous tissue deposition, and increased susceptibility to infections. The end result is permanent disfigurement and dermal changes. Early and accurate diagnosis is essential, since lymphedema is a chronic and progressive problem. When lymphedema affects the lower extremity, it is important to manage it in a way that preserves function and mobility. Early diagnosis also allows for a proactive rather than reactive approach to treatment and utilization of novel physiologic procedures, such as lymphovenous anastomosis and vascularized lymph node transfer. Such interventions slow down disease progression and reduce morbidity by allowing the surgeon to salvage the remaining functional lymphatic channels. When physiologic procedures fail or when faced with a delayed presentation, the addition of excisional procedures can provide a more comprehensive treatment of this debilitating disease. The aim of this article is to review the most current concepts in the surgical management of lower extremity lymphedema.