Northeastern Society of Plastic Surgeons

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Debulking Lymphatic Liposuction Extends Its Therapeutic Reach from One Limb to Another Limb
Melis Salman, Shih-Lun Lo, Sonia Pandey, Ali Foroutan, Wei F. Chen
Plastic Surgery, Cleveland Clinic, USA

Background: Lymphedema, characterized by chronic lymphatic dysfunction, is traditionally managed with localized treatments focused solely on the directly affected areas. Previous research into Minimally Invasive Tissue Excision with possible Skin Excision (MITESE) liposuction has not only confirmed its efficacy in removing pathological bulk but also revealed its potential to significantly enhance lymphatic drainage, suggesting profound systemic therapeutic benefits.

Methods: We conducted a retrospective analysis on 37 patients who underwent 39 MITESE procedures from January to June 2023 at a single facility. We utilized pre- and post-operative indocyanine green (ICG) lymphography and 3D volumetric analysis to evaluate changes in lymphatic function and limb volume. MITESE liposuction was performed under general anesthesia using the tumescent technique, and the procedure was concluded when the desired anatomical contour was achieved or when dense fibrosis prevented further tissue retrieval. Excess skin was excised in cases of significant skin redundancy.

Results: Post-operative ICG lymphography indicated improvement in all 37 surgical limbs. Among the 25 patients with multiple limb involvement, 24 showed enhanced lymphatic function in non-operated limbs, indicating a systemic effect of the surgery. The average volume reduction was 24.8% in treated limbs and 13.4% in untreated limbs. There were no significant differences in BMI, gender, or lipoaspirate volume between the primary and secondary lymphedema groups, though a notable age difference was observed with the primary group being younger.
Conclusion: Our findings affirm that debulking lymphatic liposuction extends beyond the targeted limb to improve systemic lymphatic drainage, thereby diminishing the overall burden of lymphedema. The observed dynamic recovery in lymphatic function post-surgery suggests that liposuction, particularly in solid state lymphedema, holds promise for broader therapeutic applications, potentially fostering significant systemic physiological improvements within the lymphatic system.

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