Compression therapy and liposuction of lower legs for bilateral hereditary primary lymphedema praecox

Abstract

In this report, we describe a case of bilateral non-syndromic hereditary lymphedema praecox of lower legs. The patient was diagnosed at age 16. Ten years later, he was unable to ambulate due to increased bilateral lower leg volume, continuous pain, and recurrent episodes of cellulitis. He was treated at our tertiary-care center with compression therapy and circumferential liposuction of lower legs, ankles, and dorsum of feet in order to remove hypertrophic fat deposits, facilitate conservative therapy, and decrease further risk of cellulitis. No complications were seen and compression therapy was continued. Fourteen month follow-up reveals no increase in leg volume over time, absence of pain, and no further episodes of cellulitis with complete ability to ambulate and return to normal activities. Even when it does not eliminate the underlying cause of primary lymphedema, combined therapy consisting of compression and liposuction is safe and is able to achieve control, at least on a short term, of clinically disabling conditions associated with advanced stages.

Circumferential suction-assisted lipectomy in the treatment of primary and secondary end-stage lymphoedema of the leg

“…In the present study, men presented more frequently with primary lymphoedema, which is in agreement with earlier aetiological studies. A few case reports have been published previously regarding the treatment of lymphoedema in men. The results in the primary lymphoedema group suggested that men have a larger persisting volume difference compared with women (median 1629 versus 275 ml), indicating that sex may be a significant factor contributing to final outcome at 2‐year follow‐up.…”

“…It was later introduced as a treatment for end‐stage lymphoedema of the leg. Remarkably, all of the published patients were women, with the exception of two case reports. After treatment with CSAL was initiated in 2004 for patients with secondary arm lymphoedema, the authors extended the method to end‐stage lymphoedema of the leg, beginning in 2006.…”

Surgical Management of Lymphedema: Past, Present, and Future

“…55 Another case report demonstrated modest reductions in leg volumes in a patient with stage III bilateral primary lymphedema (40% at 14 months) with symptomatic relief and decreased episodes of cellulitis. 58 In general, circumferential liposuction for lymphedema is safe with few reported postoperative complications. Most patients recover quickly and are discharged within 48 hours following surgery.…”

Successful management of persistent lower extremity lymphedema with suction-assisted lipectomy

“…Liposuction, or suction-assisted lipectomy, was originally theorized as a treatment for lymphedema because of the potential to directly address the adipose hypertrophy inherent to this condition ( Dixon, 2010 , Brorson, 2011 ). Additionally, liposuction is ostensibly a viable option because the procedure extracts significant, hypertrophic fat deposits without incurring excessive incisions ( Espinosa-de-Los-Monteros et al, 2009 ). Select reports have indicated that the procedure can be successfully employed in the management of lower extremity lymphedema ( Espinosa-de-Los-Monteros et al, 2009 , Eryilmaz et al, 2009 ) although there is some concern for the manifestation of cellulitis ( Inghammar et al, 2014 ).…”

“…Conventional treatment for lymphedema predominantly incorporates manual lymph drainage, compression garments, self-bandaging and diuretics ( Espinosa-de-Los-Monteros et al, 2009 ). When addressing more intractable or severe cases, excisional surgery has been employed to abstract edematous tissue ( Garza 3rd et al, 2017 ).…”