PurposeThis research describes and evaluates a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities.MethodsA prospective clinical study was conducted at an Advanced Lymphedema Assessment Clinic (ALAC) comprised of specialists in plastic surgery, rehabilitation, imaging, oncology, and allied health, at Macquarie University, Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the ALAC. Eligibility criteria for liposuction included (i) unilateral, non-pitting, International Society of Lymphology stage II/III lymphedema; (ii) limb volume difference greater than 25 %; and (iii) previously ineffective conservative therapies. Of 55 eligible patients, 21 underwent liposuction (15 arm, 6 leg) and had at least 3 months postsurgical follow-up (85.7 % cancer-related lymphedema). Liposuction was performed under general anesthesia using a published technique, and compression garments were applied intraoperatively and advised to be worn continuously thereafter. Limb volume differences, bioimpedance spectroscopy (L-Dex), and symptom and functional measurements (using the Patient-Specific Functional Scale) were taken presurgery and 4 weeks postsurgery, and then at 3, 6, 9, and 12 months postsurgery.ResultsMean presurgical limb volume difference was 45.1 % (arm 44.2 %; leg 47.3 %). This difference reduced to 3.8 % (arm 3.6 %; leg 4.3 %) by 6 months postsurgery, a mean percentage volume reduction of 89.6 % (arm 90.2 %; leg 88.2 %) [p < 0.001]. All patients had improved symptoms and function. Bioimpedance spectroscopy showed reduced but ongoing extracellular fluid, consistent with the underlying lymphatic pathology.ConclusionsLiposuction is a safe and effective option for carefully selected patients with advanced lymphedema. Assessment, treatment, and follow-up by a multidisciplinary team is essential.

Lymph node metastasis occurs in 14% of patients with high-risk cutaneous SCC. Larger studies will be required to identify which "high-risk" factors should be considered as an indication for surgical assessment of the nodal basin. © 2015 Wiley Periodicals, Inc. Head Neck 38: E884-E889, 2016.

Chronic non-healing wounds affect a significant number of patients worldwide. Although the etiologies of these wounds are varied, bacterial infection has been suggested as a major factor responsible for the perpetual inflammation and tissue destruction observed in such wounds. Recent evidence has emerged suggesting that bacterial biofilms in particular may have a significant role in this process. At the same time, topical negative pressure dressing is gaining acceptance as a therapy which promotes healing in recalcitrant wounds. In this study an in vitro Pseudomonas aeruginosa biofilm model was developed to mimic potential surface wound biofilms. Topical negative pressure dressing was applied to the model and the effects of topical negative pressure dressing on the in vitro wound biofilms were examined using both quantitative microbiological counting technique and imaging studies. The results demonstrated a small but statistically significant reduction in biofilm bacteria at 2 weeks when exposed to topical negative pressure. When this was combined with silver impregnated foam, the reduction was far more significant and was observable within 24 hours. Microscopically, it was also noted that topical negative pressure compressed the biofilm architecture with a reduction in thickness and diffusion distance.