SUCTION ASSISTED PROTEIN LIPECTOMY (SAPL) EVEN FOR THE TREATMENT OF CHRONIC FIBROTIC AND SCARIFIED LOWER EXTREMITY LYMPHEDEMA

Abstract

Chronic lymphedema results from the
accumulation of adipose tissue and fibrotic
solids and poses a significant challenge for the
treating clinician. Despite its many challenges,
chronic lymphedema can be safely and
effectively treated using a minimally invasive
technique known as suction assisted protein
lipectomy (SAPL). We present the use of
SAPL in a 65-year-old female with a history
of chronic, congenital, non-compressible, solid
predominant lymphedema for over 40 years.
Her lymphedema was complicated by multiple
episodes of severe cellulitis that often required
hospitalization and treatment with intravenous
antibiotics. The patient also had an
excisional procedure designed to debulk the
lymphedema swelling performed over 35 years
prior by an outside provider. The procedure
resulted in substantial scarring and fibrosis
between the skin and underlying fascia over a
significant area of the leg with only minimal
improvement in symptoms. Following SAPL, a
stable excess volume reduction of 86% was
achieved along with a significant improvement
in range of motion of the knee. Furthermore,
the patient had no further episodes of recurrent
cellulitis. We have found SAPL to be effective
even in patients with complex, chronic lymphedema
presentations with extensive preexisting
scarring from prior surgery..