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Massive Localized Lymphedema in morbidly obese patients: a 5 patient case report on surgical intervention
Amy Hiuser MD, Andrea Moreira-Gonzalas MD
Cleveland Clinic General Surgery Residency
Hospital based
2012-02-15
Presenter: Amy Hiuser
Affidavit:
Paper written by resident and many of the surgeries performed by resident. Staff provided guidance and editing.
Director Name: Dr A. Siperstein
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: General Reconstruction
How does this presentation meet the established conference educational objectives?
This presentation addresses a common problem encountered in today's society with the prevalence of morbid obesity. Massive Localized Lymphedema is a difficult condition manage and traditionally surgery does not play a role. Out experience surgically resecting lymphedema is providing a potential lasting therapy which greatly impacts a patient's quality of life.
How will your presentation be used by practicing physicians in the audience?
Our presentation may inspire practicing surgeons in the audience to attempt a resection of massive localized lymphedema refractory to medical management.
Massively localized edema is a life altering condition that does not have a standardized effective treatment. The majority of patients are managed with compression stockings and diuretic therapy, often to no avail. Traditionally surgical involvement provides a limited role. Massive localized lymphedema is a fairly recent topic in regards to its documentation in the surgical and reconstructive literature.
We are reporting a case series of 5 morbidly obese individuals, all with massive localized lymphedema. These individuals' lymphedema has created an immense impact on their daily living and functionality. They're frequent hospitalizations with recurrent cellulitis and then need for chronic antibiotic therapy lead all 5 to proceed to surgical resection.
These five patients underwent surgical removal of their lymphedematous masses in combined with the use of Wound V.A.C. (Kinetic Concepts, Inc. San Antonio, TX) and 2 patients with subsequent split thickness skin grafts for reconstruction.
Subjectively, all patients have experienced great improvement with mobility, quality of life, and a decrease in recurrent cellulitis requiring hospitalization. No evidence of recurrence at 6 month follow up.
