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    Liposuction for chronic lymphoedema

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    2 The condition, current treatments and procedure

    The condition

    2.1 Lymphoedema is the abnormal accumulation of subcutaneous fluid and fat in body tissues. It leads to chronic swelling that can cause disability, pain, and cosmetic issues. Any part of the body can be affected, but the condition is most common in the arms and legs. Lymphoedema can be complicated by recurrent infection (cellulitis), which further damages the lymphatic vessels and aggravates the condition. Primary lymphoedema results from a congenital inadequacy and gradual occlusion of lymphatics. Secondary lymphoedema results from damage to the lymphatic system or removal of lymph nodes by surgery, radiation, infection, or injury. In the UK, one of the most common types of chronic lymphoedema is secondary lymphoedema of the arm after breast cancer or its treatment.

    Current treatments

    2.2 Current conservative treatments for lymphoedema include manual lymphatic drainage, which stimulates the movement of lymph away from the affected limb, and decongestive lymphatic therapy. Decongestive lymphatic therapy combines manual lymphatic drainage massage techniques with compressive bandaging, skin care and decongestive exercises. Once decongestive lymphatic therapy sessions are stopped, the person is fitted with a custom-made compression garment, which is worn every day for life. These techniques aim to reduce the pain and discomfort associated with lymphoedema. In severe cases, in people with lymphoedema that does not respond to conservative treatment, surgery can be used. Surgery includes liposuction to reduce the size of the limb, and procedures to restore lymphatic flow from the limb. These procedures include constructing an alternative lymph drainage pathway via lymphovenous anastomosis, or through lymph node transfer from a donor site.

    The procedure

    2.3 Liposuction for chronic lymphoedema is usually done under general anaesthesia, but regional nerve blockade is also possible. A tourniquet is applied to the proximal limb. A few small incisions are made in the limb. Cannulas, connected to a vacuum pump, are inserted into the incisions and oedematous adipose tissue is removed by vacuum aspiration. Liposuction is done around and all the way along the limb up to the distal border of the tourniquet. The tourniquet is then removed, the proximal limb, unable to be controlled by tourniquet, is infused with tumescent solution, and the fat and fluid from this area are aspirated. Immediately after liposuction, a compression bandage is applied to the limb to control any bleeding and to prevent post-surgical oedema. Antibiotics and prophylaxis against venous thromboembolism are typically prescribed before and after the operation. After the procedure, a custom-made compression garment must be worn for life to maintain the volume reduction. This garment needs to be revised multiple times until the oedema volume has been reduced as much as possible and a steady state has been reached, but must still be worn for life.