Mean Subcutaneous Thickness Research Articles

Changes on noncontrast magnetic resonance imaging following lymphatic surgery for upper extremity secondary lymphedema

ObjectiveTo assess changes in noncontrast magnetic resonance imaging (MRI)-based biomarkers after upper extremity lymphedema surgery. MethodsWe retrospectively identified secondary upper extremity lymphedema patients who underwent vascularized lymph node transplant (VLNT), debulking lipectomy, or VLNT with a prior debulking (performed separately). All patients with both preoperative and postoperative MRIs were compared. An MRI-based edema scoring system was used: 0 (no edema), 1 (<50% fluid from myofascial to dermis), and 2 (≥50% fluid from myofascial to dermis). Edema scores and subcutaneous thickness (ST) were obtained along four quadrants across the upper and lower third of the arm and forearm each—for a total of 16 anatomical locations—and compared before and after surgery. Net changes in edema scores and ST were then correlated with Lymphoedema Quality-of-Life Questionnaire scores, L-Dex (bioimpedance), and limb volume difference by perometry. ResultsPatients who underwent lymphatic surgeries between January 2017 and December 2022 and successfully completed preoperative and postoperative MRI were included, resulting in a total of 33 unilateral secondary upper extremity lymphedema patients m(mean age, 63 ± 14 years; 32 female). The median postoperative follow-up times were 12.5 months (range, 6-19 months) for VLNT, 13.5 months (range, 12-40 months) for debulking, and 12.0 months (range, 12-24 months) for patients who underwent VLNT after debulking surgery. There was a decrease in mean ST in 15 of 16 anatomical segments of the upper extremity after debulking (P < .001), and the edema score increased in 7 of 16 segments (P ≤ .001-.020). Edema stage did not change in patients who underwent VLNT only or VLNT after debulking. ST decreased only along the radial forearm in patients who underwent VLNT after debulking despite an improvement in the Lymphoedema Quality-of-Life Questionnaire score in the former group. There was correlation between a decrease in ST with a decrease in volume within the debulking group (r = 0.79; P < .001). A decrease in ST also correlated with improved lymphedema quality of life questionnaires in the debulking group (r = 0.49; P = .04). ConclusionsA decrease in ST was demonstrated in most anatomical segments after liposuction debulking, whereas edema stage was increased. Fewer changes were seen with VLNT, possibly a reflection of more gradual changes within this short follow-up period, with the radial forearm potentially revealing the earliest response.

Ultrasonographic Measurement of Skin and Subcutaneous Thickness at Insulin Injection Sites among Adult Filipinos with Diabetes

Objectives. To determine the skin and subcutaneous thickness of adult diabetic Filipinos using ultrasonography. Methodology. We studied 293 Filipino diabetic adults who had ultrasonographic measurements of their skin thickness (ST) and subcutaneous thickness (SCT) at common insulin injection sites. Results. The mean ST ranges from 1.76 mm to 2.75mm. The mean SCT ranges from 6.91 mm to 19.1 mm. The anterior thigh area has the thinnest mean ST and SCT. On the other hand, the buttocks have the thickest mean ST and area of abdomen has the thickest mean SCT. On multiple regression analysis, the predictors for skin thickness are injection site, age, BMI, gender and insulin use, however the overall influence of all these factors on skin thickness is variable at best. Conclusion. Skin thickness among Filipinos varies marginally depending on injection site being thickest at the buttocks and thinnest at the thighs. On the other hand, there is greater variability in SCT depending on the injection site, being thickest at the abdominal area and thinnest at the anterior thigh.