Treatments Of Lymph Edema Of Skin By Liposuction Canula

CASE REPORT

TREATMENT OF CHRONIC LYPHEDEMA OF THE LEGS BY SUCTION WITH LOW MORBIDITY RATE Author: Dr. Kamal H. Saleh M.B.CH.B.(F.I.C.M.S.),HEAD OF PLASTIC SURGERY DPARTMENT IN AL EMADI HOSPITAL-QATAR-DOHA Key word: chronic lyphedema, suction

Abstract Case 20 years male patient complainnig of sever swelling (chronic lyphedema )of both legs, thighs, with very big mass more than 10 cm in diameter since birth, increasing in the size gradually up to 30 cm now, with interference of function or movement of the paient (he cant married). He underwent multiple sessions of suctions of abnormal tissues by liposuction canula in few weeks apart, We measure the size of the lesion before each session &record the regression of the lesion with very low morbidity rate. The patients followed for 2 year with no recurrences.

Introduction Lymphedema is a chronic, debilitating condition that has traditionally been seen as refractory or incurable.(3) Lymphedema occurs when lymphatic fluid builds up in the soft tissues of body, usually in an arm or leg. The lymphatic system consists of lymph vessels and lymph nodes that run through body. Lymph vessels collect a fluid that is made up of protein, water, fats, and wastes from the cells of the body. Lymph vessels carry this fluid to your lymph nodes. Lymph nodes filter waste materials and foreign products, and then return the fluid to blood. If vessels or nodes become damaged or are missing, the lymph fluid

cannot move freely through the system. The fluids can then build up and cause swelling in the affected arms or legs. Males develop edema at an earlier age and have more problems with cellulitis than females.(1)

There are two types of lymphedema:

• Inherited lymphedema, or primary lymphedema, in which are born lacking lymph vessels and nodes. The swelling usually appears during adolescence and affects foot or calf. A rare form of primary lymphedema develops in infancy and is called Milroy’s disease is characterized by lower limb lymphedema, present at birth or developing soon after and sometimes later in life.(2)

• Acquired lymphedema or secondary lymphedema, in which an injury to lymphatic system causes lymphedema. It is much more common than primary lymphedema or may be due to Lymphatic filariasis (LF) is endemic in approximately 80 tropical and subtropical countries (5)

Skin changes can occur in an untreated or inadequately treated lymphoedematous limb over a period of time (6). Excisional or suction-assisted lipectomy may be considered in patients who fail conservative therapy(7)

Some people develop chronic lymphedema, which can last for the rest of life. Chronic lymphedema (chronic swelling of the extremities caused by an intrinsic dysfunction of the lymphatic vessels) (1)can be a difficult form of lymphedema to treat. Swollen limbs become vulnerable to infection. Any kind of injury to the skin, such as a cut, scratch, insect bite, or even athlete’s foot between toes can cause a severe infection, which physicians call lymphangitis. Lymphangitis affects the connective tissue under skin. Repeated infections can cause scarring that makes the tissue vulnerable to more swelling and infection. This leads to the tissue hardening, called fibrosis, which is characteristic of advanced chronic lymphedema. Lymphedema can be an indicator of recurrence and is frequently associated with toxicities such as skin breakdown, pain, neuropathy, and myopathy(4)

CASE REPORT (PATIENT &METHODS)

Patients with chronic lyphedema, with swelling in both legs,since birth, with gradually increasing mass in thigh that interfere with movement and function, This patient is male of 20 years age,un married He underwent suction by ordinary liposuction canula in multiple session 8-12 weeks apart, with small incisions in affected area, with suction of all abnormal underneath (skin) tissues that formed by chronic lyphedema, after infilteration of the area by( dilute Ted adrenaline + normal saline=1/200000).we measure the sizes(wediths) of lesions after each sessions to record amount of regression in the size. After each session we put pressure bandaging on the areas that suctioned and keep this continuously for 4-6 weeks except the time for bathing. We follow up the patient for 2 years.

Results The result is very promising, the size of mass reduced to 80% The widths of legs reduce 50% with in few months. 30cm diameter of the mass

25cm widths of RT leg 30cm width of LFT LEG

become 3.5cm

after suction 12.5 cm After suction 14cm

The patient discharge from hospital in same day of operation with out any complications after 2 years he married and his wife is pregnant now.

Discussion The treatment of lyphedema in other (traditional ) methods like excision and skin graft associated with many complications,like sever blood loss, failure of skin graft taking, the morbidity and mortality rate is higher if we compare it with the suction by canul, also total excision with skin grafting or reduction plasty seldom achieved acceptable cosmetic and functional results (8).

And the patients should stay in hospital for few days after surgery, prolonged surgical procedure , and the procedure should done under general anesthesia, also high recurrence rate with no cure for the edema is available in certain type of lymphedema (2) in traditional methods . In suction procedure we do only small incisions in the skin, the loss of blood is lesser than excision surgical procedures, very low morbidity and mortality because we can do it under local anesthesia, and the patient can leave the hospital in the same day. Most type of lympedema can treated by this method. By Liposuction we removes the hypertrophied adipose tissue and is a prerequisite to achieve complete reduction. The new equilibrium is maintained through constant (24hour) use of compression garments postoperatively. Long-term follow up does not show any recurrence of the edema(8) with better cosmetic appearances

REFRENCES: 1- Sahar Mansour, FRCP Lymphedema with Distichiasis]

Sahar Mansour, FRCP Consultant Geneticist SW Thames Regional Genetics Department St George's, University of London .pubmed

29, 2005

2- Glen W Brice [Hereditary Lymphedema, Type I; Milroy Congenital Lymphedema] Glen W Brice, RGN BSc (Hons) SW Thames Regional Genetics Department St George's, University of London-pudmed- April 06, 2006.

3-WAREN AG

Lymphedema: a comprehensive review. Ann Plast Surg. 2007 Oct;59(4):464-72. Review. PMID: 17901744 [PubMed

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5-WYND S. Understanding the community impact of lymphatic filariasis: a review of the sociocultural literature. Bull World Health Organ. 2007 Jun;85(6):493-8. Review. PMID: 17639248 [PubMed - indexed

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7-WARREN AG. Evaluation and management of the fat leg syndrome. Plast Reconstr Surg. 2007 Jan;119(1):9e-15e. Review. PMID: 17255648 [PubMed - indexed for MEDLINE

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