CONTROLLED COMPRESSION AND LIPOSUCTION TREATMENT FOR LOWER EXTREMITY LYMPHEDEMA

Abstract

In 1987 we noticed excess adipose tissuein a patient with arm lymphedema and later,objective studies confirmed this clinical findingin patients with non-pitting arm lymphedemafollowing breast cancer. A prospective studywas begun in 1993, and its long-term results(15 years) shows overall complete reduction ofthe excess volume in patients with non-pittingarm lymphedema and that adipose tissuedominates the excess volume. Encouraged bythese results we operated on a patient withprimary and secondary elephantiasis of the leg.The edema was first transferred from a pittingto a non-pitting state by controlled compressiontherapy. Then liposuction was performed toremove the remaining excess adipose tissue,and complete reduction was finally achieved.The patient wears compression garmentscontinuously and during the 11 years of followup,no recurrence has occurred. This paperexplains our philosophical approach: a pittinglymphedema first should be treated conservativelyto remove excess fluid, then liposuctioncan be performed to remove remaining excessvolume bothersome to the patient.