136. A Combined Surgical Approach for Recalcitrant Upper and Lower Extremity Lymphedema: Lipoaspiration and Skin Excision for Improved Patient Outcomes
Year: 2025
Type: article
Study design: Observational Study
Abstract: PURPOSE: Surgical management of lymphedema consists of multiple options including lymphaticovenous bypass, vascularized lymph node transfer, and skin excision. Lipoaspiration alone has demonstrated improvement in advanced lymphedema when medical therapy is ineffective, but must be combined with lifelong decongestive therapy. Although the single-stage combination of skin excision with lipoaspiration has been sparsely documented in the literature, the reduction of skin envelope following skin excision has the potential to create physiologic compression of tissue to prolong reduced volume from lipoaspiration. We propose that in recalcitrant lymphedema, treatment with a single procedure approach combining skin excision and lipoaspiration is an effective and safe intervention. METHODS: 31 patients who underwent surgical treatment for lymphedema at our institution from 2021-2024 were retrospectively reviewed for preoperative, operative, and postoperative parameters. The percent difference in volume between the affected and unaffected extremity was calculated as the excess volume. RESULTS: 26 patients underwent combined lipoaspiration and skin excision of either upper or lower extremities (Upper Extremity: 21 patients, Lower Extremity: 5 patients). Average age at time of procedure was 65 years. Three of these patients previously underwent surgical treatment for lymphedema. All patients had previously undergone extensive lymphedema therapy with minimal improvement. Mean time to follow up postoperatively was 150 days. Mean skin excision sizes for upper and lower extremities were 180 cm2 (SD: 80 cm2) and 352 cm2 (SD:140 cm2), respectively. Mean lipoaspirate volumes for upper and lower extremities were 1240 mL (SD: 920 mL) and 2740 mL (SD: 1010 mL), respectively. The mean excess volume of the pre- and post-operative affected extremity was 29% (SD: 22%) and 9% (SD: 20%) respectively. Patients who received the combined procedure had a 19% (SD: 15%) reduction in volume of the affected extremity after surgery. There were no operative complications and two early postoperative infections that resolved with antibiotics. CONCLUSIONS: For patients that did not experience improvement with conservative lymphedema therapy, this combined surgical approach allowed for a reduction in extremity volume. Furthermore, this combined procedure contributed to reduction of excess mass and pain, increased range of motion and strength, and improved quality of life. This study demonstrates the safety and efficacy of a single stage approach to lymphedema surgery which expedites the treatment phase by avoiding a staged procedure. The direct skin excision in single stage provides additional physiologic compression akin to an external compressive device which continues to improve outcomes for those battling advanced lymphedema.
Authors: Katja Klosterman, Ritu Bhalerao, Natalya Foreman, Michael Broderick, Michel Saint-Cyr
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,195
OpenAlex ID: W4409786727