Single-stage VASER-assisted liposuction and lymphatico-venous anastomoses for the treatment of extremity lymphedema: a case series and systematic review of the literature

A paradigm shift towards the use of combined physiological and excisional surgical approaches for the treatment of lymphedema is permeating the surgical practice worldwide. We describe a single-stage surgical approach combining-vaser assisted liposuction (VAL) and lymphatico-venous anastomoses (LVA)...

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Bibliographic Details
Published in:Gland surgery 2020-04, Vol.9 (2), p.545-557
Main Authors: Ciudad, Pedro, Manrique, Oscar J, Bustos, Samyd S, Agko, Mouchammed, Huang, Tony Chieh-Ting, Vizcarra, Luis, Nuñez, Marco Lazo, Lo Torto, Federico, Forte, Antonio J
Format: Article
Language:English
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Original on Lymphedema
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Summary:A paradigm shift towards the use of combined physiological and excisional surgical approaches for the treatment of lymphedema is permeating the surgical practice worldwide. We describe a single-stage surgical approach combining-vaser assisted liposuction (VAL) and lymphatico-venous anastomoses (LVA) for the treatment of extremity-lymphedema. Between March 2018 and March 2019, a retrospective review of patients with extremity-lymphedema stage IIb-III International Society of Lymphology who underwent the combined technique was done. Demographics, operative characteristics, clinical outcomes and complications were assessed. Additionally, a systematic review of studies that reported combined physiological procedures with liposuction for the treatment of lymphedema was conducted. A total of 24 patients [12 upper extremity lymphedema (UEL), and 12 lower extremity lymphedema (LEL)] were included and analyzed. The mean age was 54.5 years (38-72 years). The mean circumference reduction rate was 90% and 85% for UEL and LEL, respectively. Infection rate decreased to zero postoperatively in all patients. Ten studies were included in the review: six pooling 220 cases included two-stage procedures, and four pooling 66 cases described one-stage surgeries. All patients who underwent a combined approach reported clinical improvement. Our combined approach is safe surgical option and allows adequate limb size reduction with faster recovery in selected patients with lymphedema with strong fibroadipose component.
ISSN:2227-684X
2227-8575
DOI:10.21037/gs.2020.01.13