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Operative Treatment of Lymphedema Using Suction-Assisted Lipectomy
Arin K. Greene, MD, MMSc, Reid A. Maclellan, M.D., M.M.Sc.
Children's Hospital Boston / Harvard Medical School, Boston, MA, USA.

Background: Surgical management of lymphedema includes removal of affected tissues (excisional procedures), or operations that create new lymphatic connections (physiologic procedures). The purpose of this study was to determine the efficacy of one type of excisional procedure, suction-assisted lipectomy, for extremity lymphedema.
Methods: Patients treated in our Lymphedema Program between 2007 and 2014 with liposuction that had post-operative follow-up were reviewed. The diagnosis of lymphedema was made by physical examination and confirmed with lymphoscintigraphy. Patient gender, age, type of lymphedema (primary or secondary), location of disease, infection history, and volume of lipoaspirate were recorded. Outcome variables were improvement in patient symptoms, reduction of extremity volume, and complications.
Results: Thirteen patients were included; mean age was 46 years (range 17-71). Six patients had secondary upper extremity lymphedema following breast cancer treatment and 7 had primary lower limb disease. Six patients had a history of repeated cellulitis involving the lymphedematous extremity. Mean lipoaspirate volume was 1612 ml (range 1200-2800) for the upper extremity and 2645 ml (range 2000-3700) for the lower limb. Post-operative follow-up averaged 3.2 years. The average reduction in excess extremity volume was 71% (range 48% to 94%). All patients reported improvement in extremity function and quality of life. No patient had recurrence or cellulitis following their procedure.
Conclusions: Suction-assisted lipectomy is an effective and safe technique to reduce extremity volume for patients with moderate or severe lymphedema. The outpatient procedure gives a significant long-term reduction in limb size, reduces the prevalence of infections, and improves quality of life.

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