SO30. Reconstructive Liposuction of Leg Lymphedema - Long Term Follow-Up

PURPOSE: Chronic lymphedema leads to local chronic inflammation that upregulates genes responsible for adipose tissue deposition. Liposuction is therefore an effective for treatment of chronic lymphedema in patients who do not fully respond to conservative treatment. Removal of the hypertrophied adipose tissue leads to complete reduction. METHODS: Inclusion criteria: Unilateral lymphedema with 10% excess volume, minimal pitting (6-7 mm) following decongestive treatment, no wounds, no ongoing infection and no active cancer.147 patients with a mean±SEM age of 49±1.3 years and with a duration of leg swelling of 13±0.9 years underwent liposuction using a combination of tumescence and tourniquet. There were 69 primary and 78 secondary lymphedemas following cancer therapy. Age at cancer treatment, interval between cancer treatment and lymphedema start, and duration of lymphedema were 42±1.7 years, 3.0±0.7 years, and 10±0.8 years respectively. Age at onset and duration of primary lymphedema was 28±1.8 years and 15±1.5 years respectively. Use of compression garments continued after surgery. RESULTS: Preoperative excess volume was 3397±149 ml. Total aspirated volume was 3410±130 ml whereof 94±0.9% adipose tissue. Postoperative reduction was 83%±2.3% at 3 months and 101±2.3% at 1 year, and more than 100% during 25 years’ follow-up. No complications such as skin necrosis or nerve damage occurred. Postoperative decreased skin sensitivity disappeared within 1-3 months. CONCLUSION: Liposuction is effective for treatment of chronic lymphedema in patients who do not respond to conservative treatment. Removal of the hypertrophied adipose tissue leads to complete reduction without recurrence. Constant use of compression garments maintains the outcome.