Abstract
Objective: There is limited information on postoperative care after liposuction for lymphedema limb. The aim of this retrospective study was to identify the threshold compression pressure and other factors that lead liposuction for lower limb lymphedema to success. Materials and Methods: Patients were divided according to whether they underwent compression therapy with both stockings and bandaging (SB group), stockings alone (S group), or bandaging alone (B group) for 6 months after liposuction. The postoperative compression pressure and rate of improvement were compared according to the postoperative compression method. We also investigated whether it was possible to decrease the compression pressure after 6 months. Liposuction was considered successful if improvement rate was >15. Results: Mean compression pressure was significantly lower in the S group than in the SB group or B group. The liposuction success rate was significantly higher in the SB group than in the B group or S group. There was not a significant difference between the values at 6 months after liposuction and at 6 months after a decrease in compression pressure in the successful group. Conclusion: Our results suggest that stable high-pressure postoperative compression therapy is key to the success of liposuction for lower limb lymphedema and is best achieved by using both stockings and bandages. The postoperative compression pressure required for liposuction to be successful was >40 mmHg on the lower leg and >20 mmHg on the thigh. These pressures could be decreased after 6 months.
Highlights
Lymphedema is divided into primary and secondary forms based on the underlying etiology
We retrospectively reviewed our patients with lower limb lymphedema who had been treated by liposuction and sought to identify factors that lead liposuction to success
All surgical procedures were performed without postoperative complications, including lymphorrhea, except for one patient who developed a 5 × 3-cm skin ulcer on the lateral aspect of the lower limb after liposuction that was treated conservatively and took 2 months to epithelialize
Summary
Lymphedema is divided into primary and secondary forms based on the underlying etiology. Cancer therapy is the leading cause of secondary lymphedema. 30% of patients who have undergone breast cancer surgery develop lymphedema of the upper limb [1]. 10–30% of patients with gynecological cancer develop lymphedema [2–4]. The Da Vinci surgical robot has been used for lymph node dissection and preventing the development of lymphedema [5]. The surgical procedures used to treat lymphedema are typically categorized as a physiological reconstruction (using lymphovenous anastomosis (LVA), or a vascularized lymphatic transplant (VLT)), or debulking using liposuction or direct excisional procedures [6]. Patients with chronic advanced lymphedema, in whom lymphatic stasis and impairment is accompanied by deposition of fibroadipose soft tissue [9,10], require debulking surgery [6,11]. Liposuction is the most common type of debulking surgery performed in these patients, and its impact has been debated since the late 1980s [12–14]
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