<< Back to the abstract archive
A Hybrid surgical approach for lymphedema management- debulk first and bypass later
Sonia Kukreja-Pandey, Ali Foroutan, Wei F Chen
Lymphatic Supermicrosurgery, Dept of Plastic Surgery, Cleveland Clinic, Ohio
2024-01-15
Presenter: Sonia Kukreja- Pandey
Affidavit:
Represents original work of the two fellows based on my patients, not previously published or presented
Director Name: Wei F. Chen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Lymphedema deposits are a mix of fluid, fat and fibrosis. Hence targeting both solid and fluid components of the disease is the logical surgical approach. Liposuction aspirates fat, breaks fibrotic septations encasing the fluid, hence reducing limb volume but requires regimental compression for maintaining results. Encouraged by our observation of enhanced ICG lymphography flow post liposuction, we offered a physiologic procedure to previously debulked patients desiring downgrade of their compression. Here we analyze our experience with this hybrid approach.
Methods: Charts of all patients who underwent LVA in previously debulked limbs between January 2020 and September 2023 were reviewed. Patient demographics, time since debulking, number and appearance of lymphatic channels anastomosed during LVA and the change in outcome measures at last follow up were analyzed.
Results: Eight females of 35-67 years age underwent LVA 2814 months after liposuction debulking (with or without skin excision) of the same limb segment (4 forearms and 4 legs). During LVA 52 lymphatics were connected using 31.5 incisions of which 7832 % lymphatic vessels were ectatic despite encasement with fibrotic tissue. At the last follow up (1 to 12 months), all patients reported reduced heaviness, swelling and pain and increased responsiveness to compression. Four patients had >3 months follow up and ICG lymphography then showed faster flow and/or new tortuous vessels. Bioimpedence and 3D camera derived limb volume confirmed reduced fluid accumulation.
Conclusion: LVA after liposuction, the hybrid approach, can further augment the outcomes of limb debulking
