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Mortada H, Alaqil S, Jabbar IA, Alhubail F, Pereira N, Hong JP, Alshomer F. Safety and Effectiveness of Liposuction Modalities in Managing Lipedema: Systematic Review and Meta-analysis. Arch Plast Surg 2024; 51:510-526. [PMID: 39345998 PMCID: PMC11436335 DOI: 10.1055/a-2334-9260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/19/2024] [Indexed: 10/01/2024] Open
Abstract
Background Lipedema is a chronic, incurable disorder characterized by painful fat accumulation in the extremities. While the application of liposuction in lipedema management has become increasingly popular, the safety and effectiveness of this approach remain contentious. Our systematic review and meta-analysis aimed to assess various liposuction modalities in lipedema management to verify their safety and efficacy. Methods In-line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed a comprehensive literature review from inception until March 2023 using the following electronic databases: CENTRAL, MEDLINE, Google Scholar, and EMBASE. Results From the 562 initially identified articles, 20 met our inclusion/exclusion criteria for evaluation. Our review encompassed 14 prospective cohort studies, 3 retrospective studies, 2 case series, and 1 cross-sectional study. A meta-analysis of nine articles revealed a notable improvement in the quality of life, pain, pressure sensitivity, bruising, cosmetic impairment, heaviness, walking difficulty, and itching among lipedema patients who underwent liposuction. Although complications such as inflammation, thrombosis, seroma, hematoma, and lymphedema-related skin changes were reported, severe complications were rare. Crucially, no instances of shock, recurrence, or mortality were reported. Conclusion Liposuction is a safe and beneficial therapeutic intervention for managing lipedema symptoms and enhancing quality of life. However, the impact of liposuction on secondary lymphedema remains unreported in the literature. Further high-quality, large-scale trials are necessary to assess the safety and effectiveness of different liposuction modalities. These studies will contribute valuable insights to optimize liposuction as a therapeutic option for individuals with lipedema. Level of Evidence I, risk/prognostic study.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sultan Alaqil
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Fatimah Alhubail
- College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia
| | - Nicolas Pereira
- Specialized Center in Lymphedema and Lipedema, Clínica Nea, Hospital del Trabajador, Región Metropolitana, Chile
| | - Joon Pio Hong
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Feras Alshomer
- Division of Plastic Surgery, Department of Surgery, King Saud Bin Abdulaziz University for Health and Sciences, Riyadh, Saudi Arabia
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Alshomer F, Lee SJ, Kim Y, Hong DW, Pak CJ, Suh HP, Hong JP. Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin Perfusion. Arch Plast Surg 2024; 51:311-316. [PMID: 38737852 PMCID: PMC11081723 DOI: 10.1055/a-2181-8469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 09/19/2023] [Indexed: 05/14/2024] Open
Abstract
Lipedema is a progressive connective tissue disease with enlargement of adipose tissue, fibrosis, fluid collection, and dermal thickening. Herein, we present a case of lipedema associated with skin hypoperfusion and ulceration in which soft tissue debulking with liposuction improved patients' symptoms. A 39-year-old female presented with asymmetric progressive initially unilateral lower limb swelling with severe pain with subsequent skin ulceration. Conservative management failed to improve her condition. After excluding other causes and detailed radiologic investigation, lipedema was diagnosed with an associated impaired skin perfusion. Trial of local wound care and compression therapy failed to improve the condition. Subsequent soft tissue debulking with circumferential liposuction and ulcer debridement and immediate compression showed dramatic improvement of the symptoms and skin perfusion. The unique nature of this case sheds light on lipedema as a loose connective tissue disease. Inflammation and microangiopathies explain the associated pain with hypoperfusion and ulceration being quite atypical and in part might be related to the large buildups of matrix proteins and sodium contents leading to fragility in microvessels with frequent petechiae and hematoma and subsequent tissue ischemia. Conservative measures like compression therapy plays a significant role in disease course. Surgical debulking with liposuction was shown to be efficacious in reducing the soft tissue load with improvement in limb pain, edema, circumference, and skin perfusion that was seen in our patient. Lipedema is a frequently misdiagnosed condition with disabling features. Skin involvement in lipedema with potential hypoperfusion was shown and it requires further investigation.
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Affiliation(s)
- Feras Alshomer
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
| | - Seok Joon Lee
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
| | - Yeongsong Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
| | - Dae Won Hong
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
| | - Changsik John Pak
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
| | - Hyunsuk Peter Suh
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
| | - Joon Pio Hong
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
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van la Parra RFD, Deconinck C, Pirson G, Servaes M, Fosseprez P. Lipedema: What we don't know. J Plast Reconstr Aesthet Surg 2023; 84:302-312. [PMID: 37390539 DOI: 10.1016/j.bjps.2023.05.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Lipedema is a loose connective tissue disease characterized by a disproportionate accumulation of adipose tissue in the limbs of women. Despite its incidence of 10-20%, lipedema is often underdiagnosed and misdiagnosed. OBJECTIVES This review aims to outline current, available evidence regarding this enigmatic syndrome and gives a synopsis of the subjects that are still unknown. MATERIALS AND METHODS PubMed and Embase searches were conducted to identify relevant articles on lipedema pathophysiology, clinical presentation, diagnosis, and treatment. RESULTS Lipedema can be considered a disease of the adipocytes or a circulatory disorder of the lymphatics. The relationship between lymphatics and adipose tissue remains controversial. The clinical distinction between lipedema, lymphedema, phlebolymphedema, and lipolymphedema can be difficult. Diagnoses often coexist, further complicating the diagnosis of lipedema, which is currently made on clinical grounds alone. The value of diagnostic imaging studies is unclear. Liposuction appears to be an effective treatment and significantly improves symptoms. CONCLUSION Diagnosing lipedema remains a challenge due to its heterogeneous presentation, co-existing diseases, and lack of objective diagnostic imaging. Further directions for research include the effect of excess skin resection surgery on lymphatic drainage.
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Affiliation(s)
- R F D van la Parra
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium.
| | - C Deconinck
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
| | - G Pirson
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
| | - M Servaes
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
| | - Ph Fosseprez
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU UCL Namur, Université Catholique de Louvain, Belgium
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Kirstein F, Hamatschek M, Knors H, Aitzetmueller-Klietz ML, Aitzetmueller-Klietz M, Wiebringhaus P, Varnava C, Hirsch T, Kueckelhaus M. Patient-Reported Outcomes of Liposuction for Lipedema Treatment. Healthcare (Basel) 2023; 11:2020. [PMID: 37510461 PMCID: PMC10379396 DOI: 10.3390/healthcare11142020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/02/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Lipedema, as a disabling and consequential disease, is gaining more awareness due to its potential omnipresence. Patients suffering from lipedema show a characteristic painful display of symmetric accumulations of adipose tissue. The combination of swelling, pain and decreased quality of life (QOL) is outstanding for the diagnosis. The aim of this study was to identify the effect of liposuction in terms of the QOL for patients and underline important factors of current and pending research regarding surgical therapy of lipoedema. METHODS Patients suffering from lipedema prior to and after receiving liposuction at our hospital were included in this study. Patients completed a lipedema-specific self-designed 50 item questionnaire: the World Health Organization Quality of Life BREF (WHOQOL-BREF) and the Patient Health Questionnaire 9 (PHQ-9). A linear mixed model was used for outcome analysis. RESULTS In total, 511 patients completed a questionnaire prior to the surgery at primary presentation to the hospital and a total number of 56 patients completed a questionnaire after liposuction. A total of 34 of these patients filled in both questionnaires prior to and after surgery. The general characteristics of the disease, such as daily symptoms and psychological health, pertinently improved after surgery. CONCLUSIONS Liposuction can have a general improving effect on the QOL of patients, both in private and professional life. Liposuction may currently be the most evident and promising method in the treatment of lipedema.
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Affiliation(s)
- Fiona Kirstein
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
| | - Matthias Hamatschek
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
| | - Henning Knors
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Marie-Luise Aitzetmueller-Klietz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Matthias Aitzetmueller-Klietz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Philipp Wiebringhaus
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Charalampos Varnava
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Tobias Hirsch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
| | - Maximilian Kueckelhaus
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Fachklinik Hornheide, 48157 Muenster, Germany
- Plastic and Reconstructive Surgery, Institute of Musculoskeletal Medicine, Westfalian Wilhelms-University, 48149 Muenster, Germany
- Division of Plastic and Reconstructive Surgery, Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, 48149 Muenster, Germany
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Rapprich S, ter Balk H, Hirsch T. Das Lipödem in Abgrenzung zur Adipositas. Parallelen und Herausforderungen in der Praxis. PHLEBOLOGIE 2022. [DOI: 10.1055/a-1935-5426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
ZusammenfassungDas Krankheitsbild Lipödem erfährt in den letzten Jahren vermehrte Aufmerksamkeit. Überschneidungen mit der Adipositas machen eine Abgrenzung mitunter schwierig. Diese ist aber für eine differenzierte zielgerichtete Therapie wichtig.
Definition und Klinik Beim Lipödem handelt es sich um eine schmerzhafte, anlagebedingte, übermäßige Fettgewebsvermehrung an den Extremitäten bei Frauen. Das führt zu einer Disproportion der Körpersilhuette. Erste Symptome manifestieren sich häufig in der Pubertät, der Verlauf ist meist progredient. Charakteristische Symptome sind Ruhe- und Druckschmerzen, Hämatomneigung, Spannungs- und Schwellungsgefühle, rasche Ermüdung der Muskulatur und Ödeme, die aber stadienabhängig inkonsistent sind. 25–88 % der Lipödem-Patientinnen leiden gleichzeitig an einer Adipositas.
Prävalenz Je nach Studie 5–9,7 %, entsprechend 2–4 Millionen Frauen in Deutschland.
Ätiologie Es besteht eine familiäre Disposition. Hormonelle Veränderungen sind Triggerfaktoren und lassen auf hormonelle Einflüsse schließen. Im Gewebe findet sich eine leichte chronische Entzündung (Silent Inflammation), welche die Symptomatik erklärt.
Diagnostik Die Diagnosestellung erfolgt klinisch und muss von anderen Fettverteilungsstörungen unterschieden werden. Der BMI ist nicht geeignet. Es sollte der Bauchumfang-Größen-Quotient (BCG = WHtR Waist to Height-Ratio) herangezogen werden.
Therapie interdisziplinärer Therapieansatz, der neben der konservativen Entstauungstherapie, der operativen Therapie mittels Liposuktion auch die Ernährungs-, Bewegungs- und Psychotherapie umfasst.
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Affiliation(s)
| | | | - Tobias Hirsch
- Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide,
- Sektion Plastische Chirurgie, Universitätsklinikum Münster,
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Podda M, Kovacs M, Hellmich M, Roth R, Zarrouk M, Kraus D, Prinz-Langenohl R, Cornely OA. A randomised controlled multicentre investigator-blinded clinical trial comparing efficacy and safety of surgery versus complex physical decongestive therapy for lipedema (LIPLEG). Trials 2021; 22:758. [PMID: 34717741 PMCID: PMC8557553 DOI: 10.1186/s13063-021-05727-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lipedema is a chronic disorder of the adipose tissue that affects mainly women, characterised by symmetrical, excessive fatty tissue on the legs and pain. Standard conservative treatment is long-term comprehensive decongestive therapy (CDT) to alleviate lipedema-related pain and to improve psychosocial well-being, mobility and physical activity. Patients may benefit from surgical removal of abnormally propagated adipose tissue by liposuction. The LIPLEG trial evaluates the efficacy and safety of liposuction compared to standard CDT. METHODS/DESIGN LIPLEG is a randomised controlled multicentre investigator-blinded trial. Women with lipedema (n=405) without previous liposuction will be allocated 2:1 to liposuction or CDT. The primary outcome of the trial is leg pain reduction by ≥2 points on a visual analogue scale ranging 0-10 at 12 months on CDT or post-completion of liposuction. Secondary outcomes include changes in leg pain severity, health-related quality of life, depression tendency, haematoma tendency, prevalence of oedema, modification physical therapy scope, body fat percentage, leg circumference and movement restriction. The primary analysis bases on intention-to-treat. Success proportions are compared using the Mantel-Haenszel test stratified by lipedema stage at a 5% two-sided significance level. If this test is statistically significant, the equality of the response proportions in the separate strata is evaluated by Fisher's exact test in a hierarchical test strategy. DISCUSSION LIPLEG assesses whether surgical treatment of lipedema is safe and effective to reduce pain and other lipedema-related health issues. The findings of this trial have the potential to change the standard of care in lipedema. TRIAL REGISTRATION ClinicalTrials.gov NCT04272827. Registered on February 14, 2020. TRIAL STATUS Protocol version is 02_0, December 17, 2019.
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Affiliation(s)
- Maurizio Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Grafenstr. 9, 64283 Darmstadt, Germany
| | - Maximilian Kovacs
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Grafenstr. 9, 64283 Darmstadt, Germany
| | - Martin Hellmich
- University of Cologne, Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Str. 10, 50924 Cologne, Germany
| | - Rebecca Roth
- University of Cologne, Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, Robert-Koch-Str. 10, 50924 Cologne, Germany
| | - Marouan Zarrouk
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Str. 269, 50935 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Joseph-Stelzmann-Str. 26, 50931 Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne Department, Herderstr. 52, 50931 Cologne, Germany
- Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann-Str. 26, 50931 Cologne, Germany
| | - Daria Kraus
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Str. 269, 50935 Cologne, Germany
| | - Reinhild Prinz-Langenohl
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Str. 269, 50935 Cologne, Germany
| | - Oliver A. Cornely
- Clinical Trials Centre Cologne (ZKS Köln), Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Str. 269, 50935 Cologne, Germany
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Joseph-Stelzmann-Str. 26, 50931 Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne Department, Herderstr. 52, 50931 Cologne, Germany
- Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Joseph-Stelzmann-Str. 26, 50931 Cologne, Germany
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Hesse U, Hesse A, Hesse L, Schultz E, Kaiser M. Lipödem heute: Zwischen konservativer Therapie, Liposuktion und Adipositaschirurgie. AKTUELLE DERMATOLOGIE 2021. [DOI: 10.1055/a-1525-5956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungDie zunehmende Prävalenz des Lipödems geht einher mit einer demografischen Zunahme der Adipositas per magna.Konservative und operative Maßnahmen ermöglichen eine ausgeprägte Befund- und Beschwerdebesserung.Die exakte Diagnose und Differenzierung zwischen therapiebedürftiger Adipositas und therapiebedürftigem Lipödem entscheiden über Erfolg und Misserfolg der eingeleiteten Therapie.Nach konservativem Therapieversuch kann die operative Versorgung bei Ausbleiben einer entsprechenden Besserung durch Liposuktion oder adipositaschirurgische Intervention bei einem erheblichen Teil der Betroffenen die konservative Therapie reduzieren bzw. teilweise sogar ganz überflüssig machen.
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Affiliation(s)
- U. Hesse
- Adipositas und Metabolische Chirurgie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
- Praxis für Chirurgie und Venentherapie, Sindelfingen
| | - A. Hesse
- Praxis für Allgemeinmedizin, Stuttgart
| | - L. Hesse
- Cand. Med. Universität Pécs, Ungarn
| | - E. Schultz
- Klinik für Dermatologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
| | - M. Kaiser
- Klinik für Plastische, Wiederherstellende und Handchirurgie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg
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Schmidt J, Kruppa P, Georgiou I, Ghods M. Management of large volume liposuction in lipedema patients with von Willebrand disease: A systematic review and treatment algorithm. Clin Hemorheol Microcirc 2021; 78:311-324. [PMID: 33814418 DOI: 10.3233/ch-201063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND When performing large volume liposuction, perioperative management of lipedema patients with coagulation disorders remains challenging due to a lack of clinical experience. With a prevalence of 1% of von Willebrand disease (VWD) in the general population, basic knowledge on diagnostic and adapted surgical strategies are essential for patients' safety. OBJECTIVE Based on a selective literature review, the purpose of this article is to present a standardized algorithm for diagnosis and perioperative treatment of VWD patients undergoing large volume liposuction. METHODS The databases MEDLINE (via PubMed) and Web of Science were selectively searched with the term "(((liposuction) OR (surgery)) OR (lipectomy)) AND (((VWD) OR (hemostaseology)) OR (von Willebrand disease))". Included were articles published in English or German until November 2020. RESULTS The evidence for large volume liposuctions in patients with VWD is limited. Experience is largely based on operations with similar bleeding risks. A safe performance requires an adjustment of the surgical technique and a customized perioperative drug substitution plan. According to the current literature, perioperative thromboembolic events appear to be rare with adequate drug treatment. CONCLUSION The implementation of the developed diagnostic and treatment algorithm may help further reducing bleeding complications and improve the safety for treated patients.
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Affiliation(s)
- Jeremias Schmidt
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/ Hand surgery, Hospital Ernst von Bergmann Clinic Potsdam, Berlin, Germany
| | - Philipp Kruppa
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/ Hand surgery, Hospital Ernst von Bergmann Clinic Potsdam, Berlin, Germany
| | - Iakovos Georgiou
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/ Hand surgery, Hospital Ernst von Bergmann Clinic Potsdam, Berlin, Germany
| | - Mojtaba Ghods
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/ Hand surgery, Hospital Ernst von Bergmann Clinic Potsdam, Berlin, Germany
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Safety of a Modified Lipoabdominoplasty Technique for Donor-Site Closure in Abdominal-Based Free Flap Breast Reconstruction. Aesthetic Plast Surg 2021; 45:1431-1440. [PMID: 33483783 DOI: 10.1007/s00266-020-02117-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/26/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aesthetic and functional outcomes of the donor site following abdominal-based free flap breast reconstruction have been suboptimal. The objective of this study is to evaluate a modified liposuction-assisted abdominoplasty technique combined with rectus plication (LPARSP) adopted from cosmetic abdominoplasty practice. PATIENTS AND METHODS All abdominal-based free flap breast reconstructions from 01/2017 to 03/2019 were reviewed. Patients with central fullness and sufficient tissue surplus on the abdomen, thighs and flanks who received LPARSP and rectus plication were identified (LPARSP group) and matched for age and body mass index with patients who underwent conventional abdominoplasty (CA group). Abdominal skin sensation, objective functional and aesthetic measures of the abdomen, as well as patient-reported outcomes (Breast-Q), were analyzed. RESULTS A total of 28 patients were included. Groups were similar in demographics. The mean amount of lipoaspirate in the LPARSP group was 1054±613.5 ml. The postoperative course was similar in both groups. The LPARSP technique resulted in a lower positioned horizontal scar (p = 0.03). The aesthetic outcome was superior in the LPARSP group (p < 0.0001). Furthermore, the LPARSP group presented with a decreased bulging rate (p = 0.05), and secondary refinement procedures were less frequently demanded (p = 0.02). In addition, the abdominal wall sensation of the flanks was improved in the LPARSP group (p = 0.05), whereby patient-reported outcome measures did not differ between groups. CONCLUSIONS Lipoabdominoplasty with rectus plication represents a safe approach for donor-site closure in selected patients undergoing abdominal-based free flap breast reconstruction. Superior functional and aesthetic results paired with improved abdominal wall sensation are achieved compared to CA. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Removal of Aquafilling Using Body-jet: A Waterjet-assisted Lipsuction Device. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3451. [PMID: 34235031 PMCID: PMC8225374 DOI: 10.1097/gox.0000000000003451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022]
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Herbst KL, Kahn LA, Iker E, Ehrlich C, Wright T, McHutchison L, Schwartz J, Sleigh M, Donahue PM, Lisson KH, Faris T, Miller J, Lontok E, Schwartz MS, Dean SM, Bartholomew JR, Armour P, Correa-Perez M, Pennings N, Wallace EL, Larson E. Standard of care for lipedema in the United States. Phlebology 2021; 36:779-796. [PMID: 34049453 PMCID: PMC8652358 DOI: 10.1177/02683555211015887] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Lipedema is a loose connective tissue disease predominantly in women identified by increased nodular and fibrotic adipose tissue on the buttocks, hips and limbs that develops at times of hormone, weight and shape change including puberty, pregnancy, and menopause. Lipedema tissue may be very painful and can severely impair mobility. Non-lipedema obesity, lymphedema, venous disease, and hypermobile joints are comorbidities. Lipedema tissue is difficult to reduce by diet, exercise, or bariatric surgery. Methods This paper is a consensus guideline on lipedema written by a US committee following the Delphi Method. Consensus statements are rated for strength using the GRADE system. Results Eighty-five consensus statements outline lipedema pathophysiology, and medical, surgical, vascular, and other therapeutic recommendations. Future research topics are suggested. Conclusion These guidelines improve the understanding of the loose connective tissue disease, lipedema, to advance our understanding towards early diagnosis, treatments, and ultimately a cure for affected individuals.
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Affiliation(s)
- Karen L Herbst
- Department of Medicine, University of Arizona, Total Lipedema Care, Beverly Hills, CA and Tucson, AZ, USA.,The US Standard of Care Committee.,Total Lipedema Care, Los Angeles, CA, USA
| | - Linda Anne Kahn
- The US Standard of Care Committee.,Lymphatic Therapy Services, San Diego, CA, USA
| | - Emily Iker
- The US Standard of Care Committee.,Lymphedema Center, Santa Monica, CA, USA
| | - Chuck Ehrlich
- The US Standard of Care Committee.,Lymph Notes, San Francisco, CA, USA
| | - Thomas Wright
- The US Standard of Care Committee.,Lipedema Surgical Solutions, O' Fallon, MO, USA
| | - Lindy McHutchison
- The US Standard of Care Committee.,Carolina Vein Center, Durham, NC, USA
| | - Jaime Schwartz
- The US Standard of Care Committee.,Total Lipedema Care, Los Angeles, CA, USA
| | - Molly Sleigh
- The US Standard of Care Committee.,Lighthouse Lymphedema Network, Atlanta, GA, USA; Centura Health, Colorado Springs, CO, USA
| | - Paula Mc Donahue
- The US Standard of Care Committee.,Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathleen H Lisson
- The US Standard of Care Committee.,Solace Massage and Mindfulness, San Diego, CA, USA
| | - Tami Faris
- The US Standard of Care Committee.,Independent Contractor, Kansas City, KS, USA
| | - Janis Miller
- The US Standard of Care Committee.,Olathe Health, Olathe, KS, USA
| | - Erik Lontok
- The US Standard of Care Committee.,Barth Syndrome Foundation, Larchmont, NY, USA
| | - Michael S Schwartz
- The US Standard of Care Committee.,Pasadena Plastic Surgery, Pasadena, CA, USA
| | - Steven M Dean
- The US Standard of Care Committee.,The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Polly Armour
- The US Standard of Care Committee.,Fat Disorders Resource Society, Laurel, MD, USA
| | | | - Nicholas Pennings
- The US Standard of Care Committee.,Campbell University School of Osteopathic Medicine, Buies Creek, NC, USA
| | - Edely L Wallace
- The US Standard of Care Committee.,Yogamatrix Studio, Orlando, FL, USA
| | - Ethan Larson
- The US Standard of Care Committee.,Larson Plastic Surgery, Tucson, AZ, USA
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12
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Schlosshauer T, Heiss C, von Hollen AK, Spennato S, Rieger UM. Liposuction treatment improves disease-specific quality of life in lipoedema patients. Int Wound J 2021; 18:923-931. [PMID: 33955179 PMCID: PMC8613387 DOI: 10.1111/iwj.13608] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/13/2021] [Accepted: 04/17/2021] [Indexed: 01/23/2023] Open
Abstract
This study examined the disease‐specific quality of life (QoL) in lipoedema patients undergoing treatment for the condition with liposuction. We conducted a retrospective analysis of all patients (n = 69) who underwent liposuction for treatment of lipoedema between 2004 and 2019, and gathered data on patient age, body mass index, the number of liposuction sessions, and the amount of fat removed per side. The study also prospectively evaluated the QoL in 20 lipoedema patients before and after liposuction using the Freiburg Life Quality Assessment for lymphatic diseases questionnaire. The mean age was 50.6 ± 12.8 years, and the average number of liposuction sessions performed was 2.9 ± 1.9, with a mean volume of 1868 ± 885.5 mL of fat removed per side. Before treatment with liposuction, disease‐specific QoL in patients with lipoedema was low on every single subscale as well as on the global score and showed a significant improvement in all aspects after liposuction. There was a significant correlation between a higher number of liposuction treatment sessions and general health status in lipoedema patients (P = .007). Liposuction greatly improves the QoL in lipoedema patients. A higher number of liposuction treatment sessions seem to have a positive effect on general health status in these patients.
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Affiliation(s)
- Torsten Schlosshauer
- Department of Plastic, Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Evangelical Hospital Giessen, Giessen, Germany
| | - Christian Heiss
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - Ann-Kathrin von Hollen
- Department of Plastic, and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt am Main, Germany
| | - Stefano Spennato
- Department of Plastic, and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt am Main, Germany
| | - Ulrich M Rieger
- Department of Plastic, and Aesthetic, Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt am Main, Germany
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13
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Survey Outcomes of Lipedema Reduction Surgery in the United States. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3553. [PMID: 33912372 PMCID: PMC8078351 DOI: 10.1097/gox.0000000000003553] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/01/2021] [Indexed: 11/26/2022]
Abstract
Background: Lipedema is a loose connective tissue disease affecting the limbs of women, that is difficult to lose by diet, exercise, or bariatric surgery. Publications from Europe demonstrate that lipedema reduction surgery improves quality of life for women with lipedema. There are no comparable studies in the United States (USA). The aim of this study was to collect data from women with lipedema in the USA who have undergone lipedema reduction surgery in the USA to determine if quality of life, pain, and other measures improved after lipedema reduction surgery. Methods: Subjects were recruited and consented online for a 166-item questionnaire in REDCap. In total, 148 women answered the questionnaire after undergoing lipedema reduction surgery in the USA. Significance set at P < 0.05 was determined by ANOVA, Tukey’s multiple comparison test, or paired t-test. Results: Quality of life improved in 84% and pain improved in 86% of patients. Ambulation improved most in lipedema Stage 3 (96%). Weight loss occurred in all stages by 3 months after surgery. Complications included growth of loose connective tissue within and outside treated areas, tissue fibrosis, anemia, blood clots, and lymphedema. Conclusions: Women with lipedema noticed significant benefits after lipedema reduction surgery in the USA. Prospective studies are needed to assess benefits and complications after lipedema reduction surgery in the USA.
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14
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Forner-Cordero I, Forner-Cordero A, Szolnoky G. Update in the management of lipedema. INT ANGIOL 2021; 40:345-357. [PMID: 33870676 DOI: 10.23736/s0392-9590.21.04604-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Lipedema is a chronic feminine disease that causes abnormal fat deposition in lower limbs and occasionally upper limbs. Easy bruising and pain are common. Lipedema patients suffer from both physical and psychological disability. Despite the relatively high prevalence and the impact on the quality of life, little is known about the disease. The majority of patients are misdiagnosed as lymphedema or obesity. The objective was to perform a non-systematic review on lipedema literature, related to diagnosis and therapy. Regarding pathophysiology, alterations are not exclusively confined to adipose tissue. Lymphatic dysfunction, cardiovascular variations, blood capillary fragility and increased permeability are common. Patients often present with neurological alterations and hormonal malfunction. Elevated cutaneous sodium has been documented. Due to the absence of a defined etiology, evidence-based research is difficult in the management of lipedema. The setting of realistic expectations is important for both patient and medical care provider. The major aims of the management are multimodal for improvements in the quality of life; reduction in heaviness and pain, reshaping the affected limbs, weight control, improvements in mobility. Compression garments, physical therapy, exercise regimens, diet and psychological counseling are necessities. For selected patients, surgical treatment is an added option.
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Affiliation(s)
- Isabel Forner-Cordero
- Lymphedema Unit, Physical Medicine and Rehabilitation Service, Hospital Universitari i Politècnic La Fe, University of Valencia, Valencia, Spain -
| | | | - Győző Szolnoky
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
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15
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Kruppa P, Georgiou I, Biermann N, Prantl L, Klein-Weigel P, Ghods M. Lipedema-Pathogenesis, Diagnosis, and Treatment Options. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:396-403. [PMID: 32762835 DOI: 10.3238/arztebl.2020.0396] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/04/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lipedema is often unrecognized or misdiagnosed; despite an estimated prevalence of 10% in the overall female population, its cause is still unknown. There is increasing awareness of this condition, but its differential diagnosis can still be challenging. In this article, we summarize current hypotheses on its pathogenesis and the recommendations of current guidelines for its diagnosis and treatment. METHODS This review is based on publications about lipedema that were retrieved by a selective search in the MEDLINE, Web of Science, and Cochrane Library databases. RESULTS The pathophysiology of lipedema remains unclear. The putative causes that have been proposed include altered adipogenesis, microangiopathy, and disturbed lymphatic microcirculation. No specific biomarker has yet been found, and the diagnosis is currently made on clinical grounds alone. Ancillary tests are used only to rule out competing diagnoses. The state of the evidence on treatment is poor. Treatment generally consists of complex decongestive therapy. In observational studies, liposuction for the permanent reduction of adipose tissue has been found to relieve symptoms to a significant extent, with only rare complications. The statutory healthinsurance carriers in Germany do not yet regularly cover the cost of the procedure; studies of high methodological quality will be needed before this is the case. CONCLUSION The diagnosis of lipedema remains a challenge because of the hetero - geneous presentation of the condition and the current lack of objective measuring instruments to characterize it. This review provides a guide to its diagnosis and treatment in an interdisciplinary setting. Research in this area should focus on the elucidation of the pathophysiology of lipedema and the development of a specific biomarker for it.
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Affiliation(s)
- Philipp Kruppa
- Department of Plastic, Aesthetic, Hand and Reconstructive Micro Surgery, Klinikum Ernst von Bergmann, Potsdam; Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg; Department of Angiology, Klinikum Ernst von Bergmann, Potsdam
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16
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van de Pas CB, Boonen RS, Stevens S, Willemsen S, Valkema R, Neumann M. Does tumescent liposuction damage the lymph vessels in lipoedema patients? Phlebology 2019; 35:231-236. [PMID: 31674863 PMCID: PMC7178148 DOI: 10.1177/0268355519885217] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Lymphatic insufficiency might play a significant role in the pathophysiology
of lipoedema. Liposuction is up to now the best treatment. As liposuction is
invasive, the technique could destruct parts of the lymphatic system and by
this aggravate the lymphatic component and/or induce lymphoedema. We
investigated the function of the lymphatic system in lipoedema patients
before and after tumescent liposuction and thus whether tumescent
liposuction can be regarded as a safe treatment. Methods Lymphoscintigraphy was performed to quantify the lymph outflow of 117
lipoedema patients. Mean clearance percentages of radioactive protein loaded
after 1 min with respect to the total injected dose and corrected for decay
of the radiopharmaceutical in the subcutaneous lymphatics were used as
functional quantitative parameters as well as the clearance percentages and
inguinal uptake 2 h post injection. The results of lymphatic function in
lipoedema patients were compared with values obtained from normal healthy
volunteers. We also compared 50 lymphoscintigraphies out of the previous 117
lipoedema patients before and six months after tumescent liposuction. Results In 117 lipoedema patients clearance 2 h post injection in the right and left
foot was disturbed in 79.5 and 87.2% respectively. The inguinal uptake 2 h
post injection in the right and left groin was disturbed in 60.3 and 64.7%
respectively. In 50 lipoedema patients mean clearance and inguinal uptake
after tumescent liposuction were slightly improved, 0.01 (p = 0.37) versus
0.02 (p = 0.02), respectively. This is statistically not relevant in
clearance. Conclusion Lipoedema legs have a delayed lymph transport. Tumescent liposuction does not
diminish the lymphatic function in lipoedema patients, thus tumescent
liposuction can be regarded as a safe treatment.
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Affiliation(s)
- Chantalle B van de Pas
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands.,Polikliniek de Blaak, Rotterdam, The Netherlands.,Kliniek De Medici, Blaricum, The Netherlands
| | | | | | - Sten Willemsen
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - Roelf Valkema
- Department of Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Martino Neumann
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
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17
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Buso G, Depairon M, Tomson D, Raffoul W, Vettor R, Mazzolai L. Lipedema: A Call to Action! Obesity (Silver Spring) 2019; 27:1567-1576. [PMID: 31544340 PMCID: PMC6790573 DOI: 10.1002/oby.22597] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/30/2019] [Indexed: 01/31/2023]
Abstract
Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women, leading to considerable disability, daily functioning impairment, and psychosocial distress. Literature shows both scarce and conflicting data regarding its prevalence. Lipedema has been considered a rare entity by several authors, though it may be a far more frequent condition than thought. Despite the clinical impact on women's health, lipedema is in fact mostly unknown, underdiagnosed, and too often misdiagnosed with other similarly presenting diseases. Polygenic susceptibility combined with hormonal, microvascular, and lymphatic disorders may be partly responsible for its development. Furthermore, consistent information on lipedema pathophysiology is still lacking, and an etiological treatment is not yet available. Weight loss measures exhibit minimal effect on the abnormal body fat distribution, resulting in eating disorders, increased obesity risk, depression, and other psychological complaints. Surgical techniques, such as liposuction and excisional lipectomy, represent therapeutic options in selected cases. This review aims to outline current evidence regarding lipedema epidemiology, pathophysiology, clinical presentation, differential diagnosis, and management. Increased awareness and a better understanding of its clinical presentation and pathophysiology are warranted to enable clinicians to diagnose and treat affected patients at an earlier stage.
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Affiliation(s)
- Giacomo Buso
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
| | - Michele Depairon
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
| | - Didier Tomson
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
| | - Wassim Raffoul
- Plastic Surgery Division, Locomotor System DepartmentLausanne University HospitalLausanneSwitzerland
| | - Roberto Vettor
- Department of Medicine, Center for the Study and the Integrated Management of Obesity (EASO COM)Padova University HospitalPadovaItaly
| | - Lucia Mazzolai
- Angiology Division, Heart and Vessel DepartmentLausanne University HospitalLausanneSwitzerland
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18
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Abstract
Lipedema is a symmetrical disorder of the subcutaneous adipose tissue that affects almost exclusively women in postpubescent age. The trinity of disfiguring hyperplastic adipose tissue of the proximal extremities, increasing pain over time and bruising is characteristic. Lymphedema can occur in both sexes and is differentiated into primary and secondary subtypes. Symmetry is not a prerequisite for diagnosis. Characteristic for lymphedema is the disproportion between lymphatic fluid and the capacity of lymphatic vessels. The most distal body parts are always more severely affected than proximal parts. In the initial phases lymphedema is painless but in advanced stages tension pain can occur. The combination of both disorders has been described; however, lipedema is not responsible for subsequent lymphedema in contrast to central obesity, which significantly increases the risk of lymphedema. The differential diagnosis is of utmost importance for a meaningful management.
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19
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Abstract
Lipedema is a symmetrical disorder of the subcutaneous adipose tissue that affects almost exclusively women in postpubescent age. The trinity of disfiguring hyperplastic adipose tissue of the proximal extremities, increasing pain over time and bruising is characteristic. Lymphedema can occur in both sexes and is differentiated into primary and secondary subtypes. Symmetry is not a prerequisite for diagnosis. Characteristic for lymphedema is the disproportion between lymphatic fluid and the capacity of lymphatic vessels. The most distal body parts are always more severely affected than proximal parts. In the initial phases lymphedema is painless but in advanced stages tension pain can occur. The combination of both disorders has been described; however, lipedema is not responsible for subsequent lymphedema in contrast to central obesity, which significantly increases the risk of lymphedema. The differential diagnosis is of utmost importance for a meaningful management.
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20
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Wollina U, Heinig B. Treatment of lipedema by low‐volume micro‐cannular liposuction in tumescent anesthesia: Results in 111 patients. Dermatol Ther 2019; 32:e12820. [DOI: 10.1111/dth.12820] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 11/24/2018] [Accepted: 01/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and AllergologyStädtisches Klinikum Dresden Dresden Germany
| | - Birgit Heinig
- Center of Physical and Rehabilitative MedicineStädtisches Klinikum Dresden Dresden Germany
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21
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Mendez BM, Coleman JE, Kenkel JM. Optimizing Patient Outcomes and Safety With Liposuction. Aesthet Surg J 2019; 39:66-82. [PMID: 29947738 DOI: 10.1093/asj/sjy151] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Since its advent in the early 1980s, liposuction has made tremendous advancements, making it the most popular aesthetic surgery performed today. The goal of this Continuing Medical Education (CME) article is to provide a foundation of knowledge of the relevant anatomy, preoperative evaluation, intraoperative technique, and postoperative management for surgeons performing liposuction. Finally, the prevention and management of potential complications will be reviewed along with measures to optimize patient safety and outcomes.
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Affiliation(s)
- Bernardino M Mendez
- Departments of Plastic Surgery and Anesthesia, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jayne E Coleman
- Departments of Plastic Surgery and Anesthesia, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey M Kenkel
- Departments of Plastic Surgery and Anesthesia, University of Texas Southwestern Medical Center, Dallas, TX
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22
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Reich-Schupke S, Schmeller W, Brauer WJ, Cornely ME, Faerber G, Ludwig M, Lulay G, Miller A, Rapprich S, Richter DF, Schacht V, Schrader K, Stücker M, Ure C. S1-Leitlinie Lipödem. J Dtsch Dermatol Ges 2018; 15:758-768. [PMID: 28677176 DOI: 10.1111/ddg.13036_g] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Die vorliegende überarbeitete Leitlinie zum Lipödem wurde unter der Federführung der Deutschen Gesellschaft für Phlebologie (DGP) erstellt und finanziert. Die Inhalte beruhen auf einer systematischen Literaturrecherche und dem Konsens von acht medizinischen Fachgesellschaften und Berufsverbänden. Die Leitlinie beinhaltet Empfehlungen zu Diagnostik und Therapie des Lipödems. Die Diagnose ist dabei auf der Basis von Anamnese und klinischem Befund zu stellen. Charakteristisch ist eine umschriebene, symmetrisch lokalisierte Vermehrung des Unterhautfettgewebes an den Extremitäten mit deutlicher Disproportion zum Stamm. Zusätzlich finden sich Ödeme, Hämatomneigung und eine gesteigerte Schmerzhaftigkeit der betroffenen Körperabschnitte. Weitere apparative Untersuchungen sind bisher besonderen Fragestellungen vorbehalten. Die Erkrankung ist chronisch progredient mit individuell unterschiedlichem und nicht vorhersehbarem Verlauf. Die Therapie besteht aus vier Säulen, die individuell kombiniert und an das aktuelle Beschwerdebild angepasst werden sollten: komplexe physikalische Entstauungstherapie (manuelle Lymphdrainage, Kompressionstherapie, Bewegungstherapie, Hautpflege), Liposuktion und plastisch-chirurgische Interventionen, Ernährung und körperliche Aktivität sowie ggf. additive Psychotherapie. Operative Maßnahmen sind insbesondere dann angezeigt, wenn trotz konsequent durchgeführter konservativer Therapie noch Beschwerden bestehen bzw. eine Progredienz des Befundes und/oder der Beschwerden auftritt. Eine begleitend zum Lipödem bestehende morbide Adipositas sollte vor einer Liposuktion therapeutisch angegangen werden.
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Affiliation(s)
| | | | | | | | | | - Malte Ludwig
- Gefäßzentrum, Benedictus Krankenhaus Tutzingen GmbH & Co. KG, Tutzingen
| | - Gerd Lulay
- Gefäß- und Lymphzentrum Nord-West am Mathias-Spital, Rheine
| | | | | | | | - Vivien Schacht
- Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover
| | - Klaus Schrader
- FA für Allgemeinmedizin, Phlebologie, Lymphologe BVL/DGL(TM)
| | - Markus Stücker
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum
| | - Christian Ure
- Lymphklinik Wolfsberg, Landeskrankenhaus Wolfsberg, Österreich
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23
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Reich-Schupke S, Schmeller W, Brauer WJ, Cornely ME, Faerber G, Ludwig M, Lulay G, Miller A, Rapprich S, Richter DF, Schacht V, Schrader K, Stücker M, Ure C. S1 guidelines: Lipedema. J Dtsch Dermatol Ges 2018; 15:758-767. [PMID: 28677175 DOI: 10.1111/ddg.13036] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The present, revised guidelines on lipedema were developed under the auspices of and funded by the German Society of Phlebology (DGP). The recommendations are based on a systematic literature search and the consensus of eight medical societies and working groups. The guidelines contain recommendations with respect to diagnosis and management of lipedema. The diagnosis is established on the basis of medical history and clinical findings. Characteristically, there is a localized, symmetrical increase in subcutaneous adipose tissue in arms and legs that is in marked disproportion to the trunk. Other findings include edema, easy bruising, and increased tenderness. Further diagnostic tests are usually reserved for special cases that require additional workup. Lipedema is a chronic, progressive disorder marked by the individual variability and unpredictability of its clinical course. Treatment consists of four therapeutic mainstays that should be combined as necessary and address current clinical symptoms: complex physical therapy (manual lymphatic drainage, compression therapy, exercise therapy, and skin care), liposuction and plastic surgery, diet, and physical activity, as well as psychotherapy if necessary. Surgical procedures are indicated if - despite thorough conservative treatment - symptoms persist, or if there is progression of clinical findings and/or symptoms. If present, morbid obesity should be therapeutically addressed prior to liposuction.
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Affiliation(s)
| | | | | | | | - Gabriele Faerber
- Vascular Center, Benedictus Hospital Tutzingen GmbH & Co. KG, Tutzingen, Germany
| | - Malte Ludwig
- Center for Vascular and Lymphatic Medicine Nord-West at the Mathias Hospital, Rheine, Germany
| | | | | | - Stefan Rapprich
- Plastic Surgery Unit, Dreifaltigkeits-Krankenhaus University Teaching Hospital Wesseling, Germany
| | - Dirk Frank Richter
- Department of Dermatology, Allergology, and Venereology, Hanover Medical School, Hanover, Germany
| | - Vivien Schacht
- Board-certified in General Medicine, Phlebology, Lymphology BVL/DGL(TM)
| | - Klaus Schrader
- Department of Dermatology, Venereology and Allergology, Ruhr University Bochum, Germany
| | - Markus Stücker
- Institute for Vascular Medicine, Recklinghausen, Germany
| | - Christian Ure
- Wolfsberg Clinical Center for Lymphatic Disorders, Wolfsberg State Hospital, Austria
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24
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Shavit E, Wollina U, Alavi A. Lipoedema is not lymphoedema: A review of current literature. Int Wound J 2018; 15:921-928. [PMID: 29956468 DOI: 10.1111/iwj.12949] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/19/2018] [Indexed: 12/15/2022] Open
Abstract
Lipoedema is a rare painful disorder of the adipose tissue. It essentially affects females and is often misdiagnosed as lymphoedema or obesity. It is globally misdiagnosed or underdiagnosed, and the literature is lacking appropriate guidance to assist clinicians towards this diagnosis. However, the need to recognise this disorder as a unique entity has important implications to establish proper treatment and, therefore, its tremendous effect on patients. Early diagnosis and treatment can turn these patients' lives upside down. The aim of this review is to focus on the clinical guidance, differential diagnosis, and management strategies. In addition, other aspects of lipoedema, including epidemiology and pathogenesis, are also being discussed here. Lipoedema is distinct from obesity and distinct from lymphoedema, although it might progress to involve the venous and lymphatic system (venolipedema or lympholipedema or both). Late diagnosis can leave the patient debilitated. Management of lipoedema includes weight loss, control of oedema, complex decongestive physiotherapy, liposuction, and laser-assisted lipolysis. However; there are increasing reports on tumescent liposuction as the preferred surgical option with long-lasting results. The role of more randomised controlled studies to further explore the management of this clinical entity remains promising.
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Affiliation(s)
- Eran Shavit
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Pouwels S, Huisman S, Smelt HJM, Said M, Smulders JF. Lipoedema in patients after bariatric surgery: report of two cases and review of literature. Clin Obes 2018; 8:147-150. [PMID: 29372593 DOI: 10.1111/cob.12239] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/14/2017] [Accepted: 11/29/2017] [Indexed: 11/26/2022]
Abstract
Lipoedema is a disorder of adipose tissue that is characterized by abnormal subcutaneous fat deposition, leading to swelling and enlargement of the lower limbs as well as the trunk. This entity is often misdiagnosed as lymphoedema or obesity and, therefore, may be overlooked and missed in patients scheduled for bariatric surgery. Patients with lipoedema who undergo bariatric surgery may have to continue to have extensive lower extremity and trunk adiposity despite adequate weight loss. In this report, we present two patients who had extensive trunk and lower extremity adiposity, one of them before and the other after the bariatric surgery.
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Affiliation(s)
- S Pouwels
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - S Huisman
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam/Schiedam, The Netherlands
| | - H J M Smelt
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands
| | - M Said
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands
| | - J F Smulders
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Obesity Center, Catharina Hospital, Eindhoven, The Netherlands
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Kaye KO, Kästner S, Paprottka FJ, Gonser P. The liquid facelift: First hands-on experience with facial water jet-assisted liposuction as an additive technique for rhytidectomy – a case series of 25 patients. J Plast Reconstr Aesthet Surg 2018; 71:171-177. [DOI: 10.1016/j.bjps.2017.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 08/25/2017] [Accepted: 10/13/2017] [Indexed: 11/27/2022]
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Abstract
ZusammenfassungHintergrund: Beim Lipödem handelt es sich um eine schmerzhafte, anlagebedingt übermäßige Fettgewebsvermehrung der Extremitäten bei Frauen. Die Ursache ist unbekannt. Ebenso unbekannt ist die Zahl der betroffenen Frauen in Deutschland. Eine eigene Untersuchung zur Epidemiologie wird vorgestellt. Als Therapiemöglichkeit stehen die Komplexe Physikalische Entstauungstherapie und die Liposuktion zur Verfügung. Nur durch die Liposuktion ist eine dauerhafte Entfernung des Fettgewebes möglich. Ihre Wirksamkeit wird in einer weiteren Untersuchung aufgezeigt und die Bedeutung als Teil eines umfassenden Behandlungskonzeptes dargelegt.Patienten und Methodik: Für die epidemiologische Untersuchung wurden in einer ländli-chen Hausarztpraxis sämtliche Patientinnen bezüglich Beinleiden untersucht. Die Studie zur Liposuktion umfasste die prä- und postoperative Untersuchung von 85 Patientinnen mittels Beschwerdefragebogen.Ergebnisse: Bei 5 % aller Patientinnen einer Hausarztpraxis wurde ein Lipödem festgestellt. Mittels Liposuktion konnten bei 85 Patientinnen Schmerzen, Druckschmerz, Hämatomneigung und Schwellungsneigung signifi-kant vermindert und die Lebensqualität verbessert werden.Schlussfolgerung: Das Lipödem ist eine relativ häufige Erkrankung der weiblichen Bevölkerung. Die Liposuktion stellt zusammen mit der prä- und postoperativen komplexen physikalischen Entstauungstherapie, einem Sportprogramm und der Behandlung einer begleitenden Adipositas sowie bedarfsweise einer psychologischen Unterstützung ein wirksames Behandlungskonzept dar.Sie kann nur im Zusammenwirken mit diesen anderen Therapien erfolgreich sein und daher ist ein umfassender Therapieplan anzustreben.
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Abstract
Liposuction is the most popular cosmetic surgical procedure performed in men. Aside from traditional liposuction using the tumescent technique, several energy-assisted liposuction technologies have emerged and been proven safe and particularly beneficial for the male patient demographic. The differences in fat distribution and unique goals and emotional perspective in men need to be taken into account when performing liposuction, to ensure meeting the patient's needs and expectations for satisfactory results.
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Liposuction in the Treatment of Lipedema: A Longitudinal Study. Arch Plast Surg 2017; 44:324-331. [PMID: 28728329 PMCID: PMC5533060 DOI: 10.5999/aps.2017.44.4.324] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/27/2017] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Lipedema is a condition consisting of painful bilateral increases in subcutaneous fat and interstitial fluid in the limbs with secondary lymphedema and fibrosis during later stages. Combined decongestive therapy (CDT) is the standard of care in most countries. Since the introduction of tumescent technique, liposuction has been used as a surgical treatment option. The aim of this study was to determine the outcome of liposuction used as treatment for lipedema. Methods Twenty-five patients who received 72 liposuction procedures for the treatment of lipedema completed a standardized questionnaire. Lipedema-associated complaints and the need for CDT were assessed for the preoperative period and during 2 separate postoperative follow-ups using a visual analog scale and a composite CDT score. The mean follow-up times for the first postoperative follow-up and the second postoperative follow-up were 16 months and 37 months, respectively. Results Patients showed significant reductions in spontaneous pain, sensitivity to pressure, feeling of tension, bruising, cosmetic impairment, and general impairment to quality of life from the preoperative period to the first postoperative follow-up, and these results remained consistent until the second postoperative follow-up. A comparison of the preoperative period to the last postoperative follow-up, after 4 patients without full preoperative CDT were excluded from the analysis, indicated that the need for CDT was reduced significantly. An analysis of the different stages of the disease also indicated that better and more sustainable results could be achieved if patients were treated in earlier stages. Conclusions Liposuction is effective in the treatment of lipedema and leads to an improvement in quality of life and a decrease in the need for conservative therapy.
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Wollina U. [Lipedema: up-to-date of a long forgotten disease]. Wien Med Wochenschr 2017; 167:343-348. [PMID: 28493139 DOI: 10.1007/s10354-017-0566-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 04/17/2017] [Indexed: 12/27/2022]
Abstract
Lipedema is a chronic disorder of subcutaneous adipose tissue of unknown etiology not uncommon among post-puberty women. The disease has a negative impact on self-esteem, mobility, and quality of life. Lipedema is characterized by symmetrical, disfiguring hyperplastic adipose tissue combined with bruising and pain. Untreated lipedema fosters osteoarthritis, secondary lymphedema, limited mobility, and psychosocial stigmatization. Treatment consists of conservative complex decongestive therapy and surgery by microcannular tumescent liposuction. Liposuction is the only available treatment capable to reduce the pathological adipose tissue durable and to prevent complications.
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Affiliation(s)
- Uwe Wollina
- Klinik für Dermatologie und Allergologie, Städtisches Klinikum Dresden, Akademisches Lehrkrankenhaus der TU Dresden, Friedrichstrasse 41, 01067, Dresden, Deutschland.
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Priglinger E, Wurzer C, Steffenhagen C, Maier J, Hofer V, Peterbauer A, Nuernberger S, Redl H, Wolbank S, Sandhofer M. The adipose tissue-derived stromal vascular fraction cells from lipedema patients: Are they different? Cytotherapy 2017; 19:849-860. [PMID: 28454682 DOI: 10.1016/j.jcyt.2017.03.073] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND AIMS Lipedema is a hormone-related disease of women characterized by enlargement of the extremities caused by subcutaneous deposition of adipose tissue. In healthy patients application of autologous adipose tissue-derived cells has shown great potential in several clinical studies for engrafting of soft tissue reconstruction in recent decades. The majority of these studies have used the stromal vascular fraction (SVF), a heterogeneous cell population containing adipose-derived stromal/stem cells (ASC), among others. Because cell identity and regenerative properties might be affected by the health condition of patients, we characterized the SVF cells of 30 lipedema patients in comparison to 22 healthy patients. METHODS SVF cells were analyzed regarding cell yield, viability, adenosine triphosphate content, colony forming units and proliferative capacity, as well as surface marker profile and differentiation potential in vitro. RESULTS Our results demonstrated a significantly enhanced SVF cell yield isolated from lipedema compared with healthy patients. In contrast, the adipogenic differentiation potential of SVF cells isolated from lipedema patients was significantly reduced compared with healthy patients. Interestingly, expression of the mesenchymal marker CD90 and the endothelial/pericytic marker CD146 was significantly enhanced when isolated from lipedema patients. DISCUSSION The enhanced number of CD90+ and CD146+ cells could explain the increased cell yield because the other tested surface marker were not reduced in lipedema patients. Because the cellular mechanism and composition in lipedema is largely unknown, our findings might contribute to a better understanding of its etiology.
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Affiliation(s)
- Eleni Priglinger
- AUVA Research Center, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Linz, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Christoph Wurzer
- AUVA Research Center, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Linz, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria; Liporegena GmbH, Breitenfurt, Austria
| | - Carolin Steffenhagen
- AUVA Research Center, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Linz, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Julia Maier
- AUVA Research Center, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Linz, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Victoria Hofer
- Faculty of Medicine/Dental Medicine, Danube Private University, Krems-Stein, Austria; Austrian Academy of Cosmetic Surgery and Aesthetic Medicine, Linz, Austria
| | - Anja Peterbauer
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Red Cross Blood Transfusion Service of Upper Austria, Linz, Austria
| | - Sylvia Nuernberger
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Bernhard Gottlieb University Clinic of Dentistry, Universitätsklinik für Zahn-, Mund- und Kieferheilkunde Ges.m.b.H, Vienna, Austria; Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Heinz Redl
- AUVA Research Center, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Linz, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Susanne Wolbank
- AUVA Research Center, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Linz, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Matthias Sandhofer
- Austrian Academy of Cosmetic Surgery and Aesthetic Medicine, Linz, Austria
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Münch D. Wasserstrahlassistierte Liposuktion zur Therapie des Lipödems. JOURNAL FUR ASTHETISCHE CHIRURGIE 2017. [DOI: 10.1007/s12631-017-0083-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Fibro-Lipo-Lymph-Aspiration With a Lymph Vessel Sparing Procedure to Treat Advanced Lymphedema After Multiple Lymphatic-Venous Anastomoses. Ann Plast Surg 2017; 78:184-190. [DOI: 10.1097/sap.0000000000000853] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lipedema: A Relatively Common Disease with Extremely Common Misconceptions. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1043. [PMID: 27757353 PMCID: PMC5055019 DOI: 10.1097/gox.0000000000001043] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/03/2016] [Indexed: 01/08/2023]
Abstract
Lipedema, or adiposis dolorosa, is a common adipose tissue disorder that is believed to affect nearly 11% of adult women worldwide. It is characterized most commonly by disproportionate adipocyte hypertrophy of the lower extremities, significant tenderness to palpation, and a failure to respond to extreme weight loss modalities. Women with lipedema report a rapid growth of the lipedema subcutaneous adipose tissue in the setting of stress, surgery, and/or hormonal changes. Women with later stages of lipedema have a classic “column leg” appearance, with masses of nodular fat, easy bruising, and pain. Despite this relatively common disease, there are few physicians who are aware of it. As a result, patients are often misdiagnosed with lifestyle-induced obesity, and/or lymphedema, and subjected to unnecessary medical interventions and fat-shaming. Diagnosis is largely clinical and based on criteria initially established in 1951. Treatment of lipedema is effective and includes lymphatic support, such as complete decongestive therapy, and specialized suction lipectomy to spare injury to lymphatic channels and remove the diseased lipedema fat. With an incidence that may affect nearly 1 in 9 adult women, it is important to generate appropriate awareness, conduct additional research, and identify better diagnostic and treatment modalities for lipedema so these women can obtain the care that they need and deserve.
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Abstract
Lipedema is an uncommon disorder characterized by localized adiposity of the lower extremities, often occurring in females with a family history of the condition. The adiposity extends from hips to ankles and is typically unresponsive to weight loss. In addition to the aesthetic deformity, women also describe pain in the lower extremities, particularly with pressure, as well as easy bruising. Although the condition is well described, it is relatively rare and often misdiagnosed. The purpose of this review is to describe the initial evaluation and diagnosis of lipedema and discuss treatment options.
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Affiliation(s)
- Anne Warren Peled
- Private Plastic and Reconstructive Surgery Practice, San Francisco, CA, USA
| | - Elisabeth A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
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Identification of the Centrifuged Lipoaspirate Fractions Suitable for Postgrafting Survival. Plast Reconstr Surg 2016; 137:67e-76e. [PMID: 26710062 DOI: 10.1097/prs.0000000000001883] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Coleman centrifugation procedure generates fractions with different adipocyte and progenitor cell densities. This study aimed to identify all fractions that are feasible for implantation. METHODS Human lipoaspirates were processed by Coleman centrifugation. The centrifugates were divided arbitrarily into upper, middle, and lower layers. Adipocyte viability, morphology, numbers of stromal vascular fraction cells, and adipose-derived mesenchymal stem cells of each layer were determined. The 12-week volume retention of subcutaneously implanted 0.3-ml lipoasperate of each layer was investigated in an athymic mice model. RESULTS Most damaged adipocytes were located in the upper layers, whereas the intact adipocytes were distributed in the middle and lower layers. A gradient of stromal vascular fraction cell density was formed in the centrifugates. The implant volume retentions of samples from the upper, middle, and lower layers were 33.44 ± 5.9, 55.11 ± 4.4, and 71.2 ± 5.8 percent, respectively. Furthermore, the middle and lower layers contained significantly more adipose-derived stem cells than did the upper layer. CONCLUSIONS The lower layer contains more viable adipocytes and stromal vascular fraction cells leading to the highest implant volume retention, whereas the most impaired cells are distributed in the upper layer, leading to the least volume retention. Although with a lower stromal vascular fraction content, the middle layer has a substantial number of intact adipocytes that are capable of retaining partial adipose tissue volume after implantation, suggesting that the middle layer may be an alternative fat source when large volumes of fat grafts are needed for transplantation.
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Lehocká D, Klich J, Foldyna J, Hloch S, Hvizdoš P, Fides M, Botko F, Cárach J. Surface Integrity Evaluation of Brass CW614N after Impact of Acoustically Excited Pulsating Water Jet. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.proeng.2016.06.662] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baumgartner A, Hueppe M, Schmeller W. Long-term benefit of liposuction in patients with lipoedema: a follow-up study after an average of 4 and 8 years. Br J Dermatol 2015; 174:1061-7. [DOI: 10.1111/bjd.14289] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
Affiliation(s)
- A. Baumgartner
- Hanse-Klinik; St-Juergen-Ring 66 D-23564 Luebeck Germany
| | - M. Hueppe
- Department of Anaesthesiology and Intensive Care; University of Luebeck; Ratzeburger Allee 160 D-23538 Luebeck Germany
| | - W. Schmeller
- Hanse-Klinik; St-Juergen-Ring 66 D-23564 Luebeck Germany
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Vial IN, Peter Rubin J. Commentary on: isolation and differentiation potential of human mesenchymal stem cells from adipose tissue harvested by water jet-assisted liposuction. Aesthet Surg J 2015; 35:1040-1. [PMID: 26427509 DOI: 10.1093/asj/sjv176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ivan N Vial
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Peter Rubin
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Meyer J, Salamon A, Herzmann N, Adam S, Kleine HD, Matthiesen I, Ueberreiter K, Peters K. Isolation and differentiation potential of human mesenchymal stem cells from adipose tissue harvested by water jet-assisted liposuction. Aesthet Surg J 2015; 35:1030-9. [PMID: 26006726 DOI: 10.1093/asj/sjv075] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In recent years the therapeutic application of extracted adipose tissue for autologous fat grafting and the application of adipose tissue-derived mesenchymal stem cells (adMSC) isolated thereof has progressed. Water-jet assisted liposuction (WAL) is 1 procedure for harvesting adipose tissue and provides a favorable aesthetic outcome combined with high tissue protection. Tissue aspirated by WAL has been successfully applied in grafting procedures. OBJECTIVES The aims of this study were to confirm the tissue viability and to understand the abundance and mesenchymal differentiation capacity of stem cells within the tissue. METHODS We analyzed tissue integrity of WAL tissue particles via fluorescence microscopy. The adMSC content was determined by isolating the cells from the tissue. The mesenchymal differentiation capacity was confirmed with cytochemical staining methods. RESULTS The stromal vascular fraction of WAL tissue showed high viability and contained an average of 2.6 × 105 CD34-positive cells per milliliter of tissue. Thus WAL tissue contains a high number of stem cells. Furthermore adMSC isolated from WAL tissue showed typical mesenchymal differentiation potential. CONCLUSIONS WAL of adipose tissue is well suited for autologous fat grafting because it retains tissue viability. Furthermore it is a valid source for the subsequent isolation of adMSC with multipotent differentiation potential. LEVEL OF EVIDENCE 3 Therapeutic.
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Affiliation(s)
- Juliane Meyer
- Mrs Meyer and Mrs Herzmann are PhD Students, Dr Salamon is a Post-doctoral Fellow, Mrs Adam is a Technical Assistant, and Dr Peters is Head of the Stem Cell Biology Group, Department of Cell Biology, Rostock University Medical Center, Rostock, Germany. Dr Kleine is on the Executive Board of Seracell Stammzelltechnologie GmbH, Rostock, Germany. Dr Matthiesen is Head of the Department of Medical Affairs, human med AG, Schwerin, Germany. Dr Ueberreiter is a Plastic Surgeon in private practice in Birkenwerder, Germany
| | - Achim Salamon
- Mrs Meyer and Mrs Herzmann are PhD Students, Dr Salamon is a Post-doctoral Fellow, Mrs Adam is a Technical Assistant, and Dr Peters is Head of the Stem Cell Biology Group, Department of Cell Biology, Rostock University Medical Center, Rostock, Germany. Dr Kleine is on the Executive Board of Seracell Stammzelltechnologie GmbH, Rostock, Germany. Dr Matthiesen is Head of the Department of Medical Affairs, human med AG, Schwerin, Germany. Dr Ueberreiter is a Plastic Surgeon in private practice in Birkenwerder, Germany
| | - Nicole Herzmann
- Mrs Meyer and Mrs Herzmann are PhD Students, Dr Salamon is a Post-doctoral Fellow, Mrs Adam is a Technical Assistant, and Dr Peters is Head of the Stem Cell Biology Group, Department of Cell Biology, Rostock University Medical Center, Rostock, Germany. Dr Kleine is on the Executive Board of Seracell Stammzelltechnologie GmbH, Rostock, Germany. Dr Matthiesen is Head of the Department of Medical Affairs, human med AG, Schwerin, Germany. Dr Ueberreiter is a Plastic Surgeon in private practice in Birkenwerder, Germany
| | - Stefanie Adam
- Mrs Meyer and Mrs Herzmann are PhD Students, Dr Salamon is a Post-doctoral Fellow, Mrs Adam is a Technical Assistant, and Dr Peters is Head of the Stem Cell Biology Group, Department of Cell Biology, Rostock University Medical Center, Rostock, Germany. Dr Kleine is on the Executive Board of Seracell Stammzelltechnologie GmbH, Rostock, Germany. Dr Matthiesen is Head of the Department of Medical Affairs, human med AG, Schwerin, Germany. Dr Ueberreiter is a Plastic Surgeon in private practice in Birkenwerder, Germany
| | - Hans-Dieter Kleine
- Mrs Meyer and Mrs Herzmann are PhD Students, Dr Salamon is a Post-doctoral Fellow, Mrs Adam is a Technical Assistant, and Dr Peters is Head of the Stem Cell Biology Group, Department of Cell Biology, Rostock University Medical Center, Rostock, Germany. Dr Kleine is on the Executive Board of Seracell Stammzelltechnologie GmbH, Rostock, Germany. Dr Matthiesen is Head of the Department of Medical Affairs, human med AG, Schwerin, Germany. Dr Ueberreiter is a Plastic Surgeon in private practice in Birkenwerder, Germany
| | - Inge Matthiesen
- Mrs Meyer and Mrs Herzmann are PhD Students, Dr Salamon is a Post-doctoral Fellow, Mrs Adam is a Technical Assistant, and Dr Peters is Head of the Stem Cell Biology Group, Department of Cell Biology, Rostock University Medical Center, Rostock, Germany. Dr Kleine is on the Executive Board of Seracell Stammzelltechnologie GmbH, Rostock, Germany. Dr Matthiesen is Head of the Department of Medical Affairs, human med AG, Schwerin, Germany. Dr Ueberreiter is a Plastic Surgeon in private practice in Birkenwerder, Germany
| | - Klaus Ueberreiter
- Mrs Meyer and Mrs Herzmann are PhD Students, Dr Salamon is a Post-doctoral Fellow, Mrs Adam is a Technical Assistant, and Dr Peters is Head of the Stem Cell Biology Group, Department of Cell Biology, Rostock University Medical Center, Rostock, Germany. Dr Kleine is on the Executive Board of Seracell Stammzelltechnologie GmbH, Rostock, Germany. Dr Matthiesen is Head of the Department of Medical Affairs, human med AG, Schwerin, Germany. Dr Ueberreiter is a Plastic Surgeon in private practice in Birkenwerder, Germany
| | - Kirsten Peters
- Mrs Meyer and Mrs Herzmann are PhD Students, Dr Salamon is a Post-doctoral Fellow, Mrs Adam is a Technical Assistant, and Dr Peters is Head of the Stem Cell Biology Group, Department of Cell Biology, Rostock University Medical Center, Rostock, Germany. Dr Kleine is on the Executive Board of Seracell Stammzelltechnologie GmbH, Rostock, Germany. Dr Matthiesen is Head of the Department of Medical Affairs, human med AG, Schwerin, Germany. Dr Ueberreiter is a Plastic Surgeon in private practice in Birkenwerder, Germany
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Chia HL, Woo E, Por YC, Ma DR, Chang K, Mok J, Kua J, Yeow V. Adipocyte and preadipocyte viability in autologous fat grafts: comparing the water jet-assisted liposuction (WAL) and Coleman techniques. EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-015-1081-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Autologous fat grafting is a widely used procedure, yet the mechanisms that regulate graft outcomes are poorly understood. Estrogen signaling is a potent regulator of lipid handling, inflammation, fibrosis, and adipocyte progenitor recruitment in adipose tissues. To date, no studies have investigated the effect of circulating estrogens on fat graft outcomes. METHODS Immunosuppressed (Nu/Nu) mice underwent ovariectomy or sham surgery. Forty-five days later, half the mice (donors) were killed, and adipose tissue was taken and transplanted into the remaining cohort (recipients). Forty-five days after transplantation, grafts were dissected, weighed, and assessed for expression of vascular endothelial growth factor, estrogen receptor-α, and vascular density. RESULTS Grafts harvested from and transplanted into sham environments are smaller but more highly vascularized compared with ovariectomy environments. The estrogenic effects on grafts are more critical at the site of the donor tissue than the recipient. Finally, expression of estrogen receptor-α in the grafted tissue correlates with the observed graft characteristics, which is altered by both the donor and recipient environments. CONCLUSIONS Circulating estrogens have significant effects on fat graft outcomes, primarily at the site of the donor tissue. As there are well-established depot-specific estrogenic responses, the choice of adipose depot used as a donor for fat grafting may affect outcomes. In addition, outcomes may be confounded by the patient's hormonal status. Understanding the mechanisms by which estrogen signaling regulates graft outcomes is important in refining this commonly used clinical procedure.
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Wollina U, Graf A, Hanisch V. Acute pulmonary edema following liposuction due to heart failure and atypical pneumonia. Wien Med Wochenschr 2015; 165:189-94. [DOI: 10.1007/s10354-014-0333-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/10/2014] [Indexed: 11/24/2022]
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Jet-assisted fat transfer to the female breast: preliminary experiences. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-014-0934-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Davis K, Rasko Y, Oni G, Bills J, Geissler P, Kenkel JM. Comparison of adipocyte viability and fat graft survival in an animal model using a new tissue liquefaction liposuction device vs standard Coleman method for harvesting. Aesthet Surg J 2013; 33:1175-85. [PMID: 24197935 DOI: 10.1177/1090820x13510526] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The use of autologous fat for augmentation has become common practice among plastic surgeons for both cosmetic and reconstructive procedures. Previously reported data suggest that the method of fat extraction can have profound effects on adipocyte viability and subsequent fat graft survival. OBJECTIVE The authors describe a pilot study comparing a new tissue liquefaction liposuction device (TLL; HydraSolve Lipoplasty System; Andrew Technologies, Irvine, California) with a standard syringe aspiration method with respect to adipocyte viability, fat graft survivability, and fat graft quality. METHODS Lipoaspirate from 5 patients was harvested using either TLL or the standard method. Samples were centrifuged and assayed for cell viability. All lipoaspirate samples were grafted into nude rats and harvested 42 and 84 days later. Graft survival and quality were assessed. RESULTS There was no difference in adipocyte viability between the lipoaspirate conditions. At 42 days, there was no significant difference in fat graft weight and the TLL grafts were more fibrotic than the standard control grafts, but this was improved with the increased centrifuge rate. At 84 days, fat grafts were equivalent with respect to graft weight and histology. CONCLUSIONS Lipoaspirate harvested with the TLL device and centrifuged at 3000 rpm resulted in fat grafts that were equivalent in weight and histology to those from lipoaspirate harvested with the standard syringe aspiration technique.
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Affiliation(s)
- Kathryn Davis
- Dr Davis is an Assistant Professor and Co-Director of Research, Dr Oni is a Research Fellow, Ms Bills is a Study Coordinator, Dr Geissler is a Research Fellow, and Dr Kenkel is a Professor and Vice-Chairman in the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Forner-Cordero I, Szolnoky G, Forner-Cordero A, Kemény L. Lipedema: an overview of its clinical manifestations, diagnosis and treatment of the disproportional fatty deposition syndrome - systematic review. Clin Obes 2012; 2:86-95. [PMID: 25586162 DOI: 10.1111/j.1758-8111.2012.00045.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 05/20/2012] [Accepted: 06/14/2012] [Indexed: 11/29/2022]
Abstract
Lipedema is a disproportionate, symmetrical fatty swelling characterized by pain and bruising existing almost exclusively among women. We undertook a systematic review of the available literature about lipedema, given the lack of knowledge and little evidence about this disorder especially among obesity experts. Diagnosis of lipedema is usually based on clinical features. Symmetrical edema in the lower limbs with fatty deposits located to hips and thighs usually appears at puberty and often affects several members of the same family. Main disorders considered for differential diagnosis are lymphedema, obesity, lipohypertrophy and phlebedema. Treatment protocols comprise conservative (decongestive lymphatic therapy) and surgical (liposuction) approaches. Early diagnosis and treatment are mandatory for this disorder otherwise gradual enlargement of fatty deposition causes impaired mobility and further comorbidities like arthrosis and lymphatic insufficiency.
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Affiliation(s)
- I Forner-Cordero
- Lymphedema Unit, Rehabilitation Department. University Hospital La Fe, Valencia, Spain
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Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol 2011; 166:161-8. [DOI: 10.1111/j.1365-2133.2011.10566.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sasaki GH. Water-assisted liposuction for body contouring and lipoharvesting: safety and efficacy in 41 consecutive patients. Aesthet Surg J 2011; 31:76-88. [PMID: 21239675 DOI: 10.1177/1090820x10391465] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Water-assisted liposuction (WAL) is a new technique for body contouring and fat harvesting that relies on a fan-shaped jet of tumescent solution to anesthetize fatty for liposuction and grafting. As with any new technology, safety and efficacy are paramount. OBJECTIVE The author evaluates the technique and outcomes for small-to-moderate volume liposuction cases treated with WAL in an office setting. METHODS Forty-one consecutive patients were treated with WAL (Body-Jet; Human Med, Eclipse Ltd., Dallas, Texas) in the author's private practice for mild-to-moderate body contouring. Patients were given local anesthesia (standardized tumescent solutions) during all three phases of the surgery. During the latter two phases, irrigation of tumescent solution was accompanied simultaneously by suction aspiration. Fat harvesting was accomplished by collecting and separating the aspirated adipose tissue in a sterile container, without need for washing or centrifugation. Fat grafting by microdroplet technique was performed within two hours of collection. Fat aliquots from five randomly-selected patients were assessed with a trypan blue dye exclusion test within one hour and again six to eight hours after collection. RESULTS A total of 37 females and four males underwent WAL in this series; average body mass index (BMI) was 25.5. Among the 41 patients, 166 areas involving twelve anatomic sites were treated. Patients were divided into two groups based on the volume of treatment: Group 1 contained 19 patients with small-volume WAL and Group 2 had 22 cases of moderate-volume WAL. All patients experienced uneventful recovery periods with minimal side effects and no significant complications. Although large volumes of tumescent solution were required during the three phases of the technique, the total volume of infiltration almost equaled the final volume of aspiration. The average infiltration-to-aspiration ratio was 1.1 to 1.0 in all cases over both groups. On the other hand, the average infiltration-to-fat ratio was 2.8 to 1.0 in Group l and 2.4 to 1.0 in Group 2. Lidocaine dosage averaged 10.5mg/kg in Group 1 and 20.0mg/kg in Group 2. Patients were monitored for at least 24 hours without adverse signs or symptoms that required fluid resuscitation, blood transfusions, or interventional treatments for lidocaine side effects or toxicity. Twenty-three patients elected to save their fat for autologous fat grafting in nine anatomical sites with thirty-nine procedures. The augmented sites were clinically assessed between three and eight months postoperatively. Trypan blue dye exclusion testing indicated that about 90% of adipocytes expelled the dye after one hour of extraction, while an estimated 10% of cells per patient were observed to be free of dye six to eight hours after removal. CONCLUSIONS The amount of instilled tumescent fluid, lidocaine dosage, and aspiration volumes appeared to be safe, with minimal blood loss in small and moderate volume liposuction cases. The early experience with fat grafting was encouraging, but requires more sophisticated evaluation, longer follow-up, and a larger number of cases.
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Affiliation(s)
- Gordon H Sasaki
- Loma Linda University Medical Center, Loma Linda, California, USA.
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Liposuction: a review of principles and techniques. J Plast Reconstr Aesthet Surg 2010; 64:985-92. [PMID: 21168378 DOI: 10.1016/j.bjps.2010.11.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 11/18/2010] [Indexed: 11/22/2022]
Abstract
For one of the most commonly performed aesthetic procedures, liposuction has a somewhat mixed reputation. This may result from suboptimal technical comprehension and/or poor patient selection. It has also attracted strong commercial pressure from manufacturers of new, sometimes less assiduously-evaluated, technologies. Liposuction is not a panacea for obesity and patients are not always cognisant of this. On the other hand, it can produce highly satisfactory outcomes for well-selected patients and anatomical areas when performed by appropriately-trained operators using properly selected technologies. Although introduced by the Europeans, liposuction was enthusiastically adopted by the North Americans, yet seems to have excited little scientific interest in the UK, despite widespread use. Given the numerous techniques and recent advances, a review may be timely.
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