Abstract: Abdominoplasty with Lymphatic Microsurgery for Patients with Lower Extremity Lymphedema

Abstract

INTRODUCTION: Patients with secondary lower extremity lymphedema (LEL) often develop suprapubic lymphedema. A majority of the cases have midline abdominal scars, with ventral herniation also observed. We developed a novel surgical method of shaping the lower abdomen and debulking suprapubic lymphedema with simultaneous reconstruction of lymphatic flow in case of LEL. METHODS: A skin incision in a fleur-de-lis pattern was performed for horizontal and vertical abdominal skin and fat resection1. A caudal-based isosceles triangular flap was created on the central suprapubic region to reduce wound tension at the intersection of the horizontal and vertical incisions. After resection and debulking of the suprapubic region, in cases with a ventral hernia, the hernial orifice was repaired directly and a monofilament polypropylene mesh. Thereafter, lymphaticovenular anastomosis (LVA) between the efferent lymphatic vessel of the groin node and the superficial inferior epigastric vein was created or vascularized lymph node transfer (LNT) to the groin region was performed to restore lymphatic flow. LVA and LNT were also performed at the lower extremities to improve LEL. Perioperative change in limb volume was evaluated using the LEL index, and lymphatic function was evaluated by lymphoscintigraphy. RESULTS: Simultaneous abdominoplasty and reconstructive lymphatic microsurgery were performed in 11 patients. The LEL index improved perioperatively, with a significant difference (p < 0.01). In eight patients who underwent lymphoscintigraphy before and after surgery, the lymphatic function was found to have not deteriorated in any limb. CONCLUSION: When simultaneous lymphatic microsurgeries and careful observation for complications were performed, abdominoplasty resulted in good outcomes in patients with LEL and suprapubic lymphedema without worsening of lymphedema.