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Klöppel M, Römich D, Machens HG, Papadopulos NA. Quality of life following liposuction for lipoedema: a prospective outcome study. J Plast Reconstr Aesthet Surg 2024; 91:70-78. [PMID: 38402815 DOI: 10.1016/j.bjps.2024.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/19/2023] [Accepted: 02/04/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND The study examines, for the first time, the impact on quality of life after liposuction for lipoedema. The influence of aesthetic plastic interventions and their effects on treatment outcomes has been a major focus of our research group over the past 20 years. METHODS A total of 35 patients were invited to participate in our prospective study, with 30 responding to both the pre- and postoperative questionnaires. The patients received the questionnaires pre-operatively, and 6 months after the liposuction. Our questionnaire set included a self-developed, indication-specific part, along with standardised and validated questionnaires such as the Questions on Life Satisfaction (FLZM), Patient Health Questionnaire (PHQ-4), Rosenberg Self-Esteem Scale (RSES) and the Freiburg personality inventory-revised (FPI-R). RESULTS Our self-developed questionnaire showed that our patients feel more balanced, more attractive and more self-confident after the treatment. The FLZM showed significant improvements in all three modules: the general satisfaction with life, the state of health and the outer appearance (body image). Using the PHQ-4, a significant improvement in the two subscales of anxiety and depression could be determined, as well as a reduction in overall mental stress. In addition, the RSES showed a significant improvement in self-esteem post-operatively. Furthermore, the FPI-R indicated a significant improvement in emotional stability. CONCLUSIONS Liposuction improves the quality of life in lipoedema patients. Post-operatively, our patients reported less pain and were more satisfied with their bodies and appearance. The hypothesis that liposuction in lipoedema improves the quality of life as a multidimensional construct could be confirmed.
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Affiliation(s)
- Markus Klöppel
- Aesthetic Surgery & Medicine, Theresium Munich, Munich, Germany
| | - Diana Römich
- Department of Plastic Surgery & Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Ismaningerstrasse 22, 81675 Munich, Germany
| | - Hans-Günther Machens
- Department of Plastic Surgery & Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Ismaningerstrasse 22, 81675 Munich, Germany
| | - Nikolaos A Papadopulos
- Department of Plastic Surgery & Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Ismaningerstrasse 22, 81675 Munich, Germany; Department of Plastic Surgery & Burns, Alexandroupoli University Hospital, Democritus University οf Thrace, Alexandroupoli, Greece; Department of Plastic Surgery, Eugenideio University Hospital, University of Athens, Athens, Greece.
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Bonetti G, Michelini S, Donato K, Dhuli K, Medori MC, Micheletti C, Marceddu G, Herbst KL, Cristoni S, Fulcheri E, Buffelli F, Bertelli M. Targeting Mast Cells: Sodium Cromoglycate as a Possible Treatment of Lipedema. Clin Ter 2023; 174:256-262. [PMID: 37994773 DOI: 10.7417/ct.2023.2496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Mast cells are immune cells that mediate hypersensi-tivity and allergic reactions in the body, secreting histamine and other inflammatory molecules. They have been associated with different inflammatory conditions such as obesity and other adipose tissue di-sorders. Lipedema is a chronic disease characterized by an abnormal accumulation of adipose tissue on the legs and arms, pain, and other symptoms. Mast cells may play a role in the pathology of lipedema. Objective Pilot study to determine levels of histamine and its metabolites in lipedema subcutaneous adipose tissue (SAT) biopsy samples, and to test sodium cromoglycate for the treatment of mast cells in women with lipedema. Methods Biopsies from lipedema and control SAT were collected and analyzed histologically for the presence of mast cells. Mass spec-trometry was used to measure the levels of histamine, a key marker of mast cells, and its metabolites in SAT in women with lipedema and controls, and after a group of women with lipedema were administered oral and topical doses of sodium cromoglycate for two weeks. Results Histological examination of biopsies from lipedema patients confirmed the presence of mast cells. Metabolomic analysis revealed high levels of histamine and its metabolites in samples from women with lipedema compared to controls. Following a two-week treatment period, lipedema tissue samples exhibited reduced levels of histamine, suggesting a reduction of mast cell activity. Conclusion Sodium cromoglycate has the ability to stabilize mast cells and reduce histamine levels in lipedema patients, which could be useful in lowering the symptoms of lipedema.
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Affiliation(s)
- G Bonetti
- MAGI'S LAB, Rovereto (TN), Italy
- Department of Pharmaceutical Sciences, University of Perugia, Italy
| | - S Michelini
- Vascular Diagnostics and Rehabilitation Service, Marino Hospital, ASL Roma 6, Marino, Italy
| | - K Donato
- MAGI EUREGIO, Bolzano, Italy
- MAGISNAT, Atlanta Tech Park, Peachtree Corners, GA, USA
| | - K Dhuli
- MAGI'S LAB, Rovereto (TN), Italy
| | | | | | - G Marceddu
- Vascular Diagnostics and Rehabilitation Service, Marino Hospital, ASL Roma 6, Marino, Italy
| | - K L Herbst
- Total Lipedema Care, Beverly Hills, California, and Tucson, Arizona, USA
| | - S Cristoni
- ISB Ion Source & Biotechnologies srl, Italy, Bresso, Milano, Italy
| | - E Fulcheri
- Division of Anatomic Pathology. Department of Surgical and Diagnostic Sciences (DISC), University of Genova, Italy
| | - F Buffelli
- Fetal-Perinatal Pathology Unit, IRCCS Istituto Giannina Gaslini, Italy
| | - M Bertelli
- MAGI'S LAB, Rovereto (TN), Italy
- MAGI EUREGIO, Bolzano, Italy
- MAGISNAT, Atlanta Tech Park, Peachtree Corners, GA, USA
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Hansdorfer-Korzon R, Czerwińska M, Teodorczyk J, Szamotulska J. Assessment of lipoedema awareness among polish women- online survey study. BMC Womens Health 2023; 23:457. [PMID: 37644422 PMCID: PMC10464337 DOI: 10.1186/s12905-023-02614-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Lipoedema is an adipose tissue disorder that is still not fully understood. The primary purpose of this study is to explore the state of knowledge and understanding of lipoedema among Polish women. The secondary aim is to investigate the possible association between knowledge and factors such as BMI, self-reported symptoms, and age. METHODS One hundred seventy polish women took part in an online survey study that was posted to social media groups and forums in January 2022. The survey consisted of 12 questions and aimed at assessing the basic knowledge about lipoedema. RESULTS The least proportion of participants (4%) could correctly indicate the methods of lipoedema treatment. The accurate definition of lipoedema was indicated only by 7% of women, 12% identified characteristic features of lipoedema, and 37% correctly evaluated lipoedema curability. The greatest proportion of respondents knew the differences between obesity and lipoedema (50%). CONCLUSIONS Awareness of lipoedema among women is deficient. A significant proportion of the respondents report the occurrence of lipoedema symptoms. In order to improve the situation of lipoedema patients, it is crucial to increase the knowledge about this condition both among medical professionals and the general public.
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Affiliation(s)
- Rita Hansdorfer-Korzon
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, Gdańsk, 80-211 Poland
| | - Monika Czerwińska
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, Gdańsk, 80-211 Poland
| | - Jacek Teodorczyk
- Department of Nuclear Medicine and Radiology Informatics, Medical University of Gdańsk, 17 Mariana Smoluchowskiego Street, 80-214, Gdańsk, Poland
| | - Jolanta Szamotulska
- Department of Physiotherapy, Medical University of Gdańsk, 7 Dębinki Street, Gdańsk, 80-211 Poland
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Rastel D, Urbinelli R. Frequency of lipoedema in patients consulting a vein clinic for mild to moderate superficial venous disorder with symptoms: A retrospective analysis. J Med Vasc 2023; 48:55-61. [PMID: 37422328 DOI: 10.1016/j.jdmv.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/05/2023] [Indexed: 07/10/2023]
Abstract
INTRODUCTION Lower limb lipoedema is a chronic condition of the adipose connective tissue of the skin that affects women. Its frequency is not well known, hence the main objective of this study. METHOD Retrospective analysis of the records of phlebology consultations in private practice in a single center from April 2020 to April 2021. Inclusion criteria were: women aged 18 to 80 years, presenting with symptoms attributable to veins and the presence of at least one dilated reticular vein. RESULTS The files of 464 patients were analyzed. 7.7% had lipoedema, 3.7% lymphedema, 3% stage 3 obesity. The 36 patients with lipoedema were 54.7±16 years old (mean, Standard Deviation), with a Body Mass Index of 31.3±5.5. Leg pain was the major symptom (32/36) and no patient had a positive pitting test. CONCLUSION Lipoedema is a frequent condition in phlebology consultations.
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Affiliation(s)
- Didier Rastel
- Vascular Physician, 30, place Louis Jouvet, 38100 Grenoble, France.
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Abstract
Lipoedema is an adipose tissue disorder almost exclusively affecting women. Evidence shows lipoedema is both poorly recognised and misdiagnosed which results in many women struggling to get a diagnosis and to gain access to specialist NHS services. This article aims to raise awareness of lipoedema and highlight the main role that community and primary care nurses can play in identifying this long-term condition earlier. It provides detail on the condition to help signpost, refer for diagnosis and initiate conservative management for those individuals with this challenging condition.
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Affiliation(s)
- Mary Warrilow
- Independent Nursing Consultant and Private Lymphoedema/Lipoedema Therapist; Nurse Consultant at LipoedemaUK; Queen's Nurse
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Dancey A, Pacifico M, Kanapathy M, MacQuillan A, Ross G, Mosahebi A. Summary document on safety and recommendations on liposuction for lipoedema: Joint British association of aesthetic plastic surgeons (BAAPS)/British association of plastic reconstructive and aesthetic surgeons (BAPRAS) expert liposuction group. J Plast Reconstr Aesthet Surg 2023; 77:400-407. [PMID: 36638756 DOI: 10.1016/j.bjps.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
Liposuction plays an important role as a surgical treatment option for lipoedema. This article serves to critically review the evidence in the literature, as well as explain the differences between the lipoedema population compared with the aesthetic surgery population undergoing liposuction. It is not a comprehensive text on lipoedema management but serves to guide surgeons. This guidance was produced on behalf of the British Association of Aesthetic Plastic Surgeons (BAAPS) and the British Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) by the expert liposuction group. The guidance is based on the evidence available in the literature, along with a specialist expert opinion on liposuction for lipoedema, to provide plastic surgeons with a consensus recommendation for surgical treatment. The aim is to identify best practice to maximise the safety of patients. This article summarises current practices and safety considerations and outlines recommendations covering various aspects of patient care.
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Affiliation(s)
- Anne Dancey
- Parkway Hospital, 1 Damson Parkway, Solihull B91 2PP, United Kingdom.
| | - Marc Pacifico
- Purity Bridge, 19 Mount Ephraim, Tunbridge Wells, Kent TN4 8AE, United Kingdom.
| | - Muholan Kanapathy
- Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, NW3 2QG, United Kingdom; Division of Surgery & Interventional Science, University College London, London, WC1E 6BT, United Kingdom.
| | | | - Gary Ross
- University of Manchester, Oxford Rd, Manchester M13 9PL, United Kingdom
| | - Afshin Mosahebi
- Purity Bridge, 19 Mount Ephraim, Tunbridge Wells, Kent TN4 8AE, United Kingdom; Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust Hospital, London, NW3 2QG, United Kingdom.
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Granger L, Bolam SM, Sur A, Mitchell P, Hutt J, Sandiford NA. Five-year results after total knee arthroplasty in lymphoedema and lipoedema: encouraging functional and clinical outcomes and low rates of infection. Int Orthop 2022; 46:2815-2820. [PMID: 36075971 PMCID: PMC9674715 DOI: 10.1007/s00264-022-05575-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to define outcomes after total knee arthroplasty (TKA) in lymphoedema and lipoedema patients managed by a multidisciplinary team and daily compression bandaging. METHODS A retrospective study was performed in a single centre. Between 2007 and 2018, 36 TKA procedures were performed on 28 consecutive patients with a diagnosis of lymphoedema and lipoedema. Oxford Knee Scores (OKS), EuroQol-5D (EQ-5D) scores, satisfaction scores, radiographs, and complications were obtained at the final follow-up. Patients were admitted to the hospital up to two weeks prior to surgery and remained on the ward for daily compression bandaging by the specialist lymphoedema team. RESULTS Over the study period, 36 TKAs were performed on 28 patients (5 males, 23 females) with a mean age of 71 years (range 54-90). Of these, 30 TKAs were in patients with lymphoedema, five with lipoedema, and one with a dual diagnosis. Overall, 28 TKAs (21 patients) were available at the final follow-up with a mean follow-up time of 61 months (range 9-138). The mean BMI was 38.5 kg/m2. The mean pre-operative and post-operative Oxford Knee Score increased from 18 (range 2-38) to 29 (range 10-54); p < 0.001. EQ-5D score increased from 0.48 (range 0.15-0.80) to 0.74 (0.34-1.00) (p < 0.001). Mean post-operative satisfaction was 7.6/10 (range 2-10), with 89.3% TKAs satisfied. Complications were one (4%, 1/28) deep vein thrombosis, one superficial wound infection, one prosthetic joint infection, one stiff knee requiring manipulation, and one intra-operative femoral fracture. CONCLUSIONS Lymphoedema and lipoedema should not be seen as barriers to TKA if adopting a multidisciplinary approach.
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Affiliation(s)
- Luke Granger
- Trauma & Orthopaedics, St George's Hospital, London, UK
| | - Scott M Bolam
- Joint Reconstruction Unit, Department of Orthopaedics, Southland Hospital, Invercargill, 9812, New Zealand
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Avtar Sur
- Trauma & Orthopaedics, St George's Hospital, London, UK
| | | | - Jonathan Hutt
- Trauma & Orthopaedics, St George's Hospital, London, UK
| | - Nemandra A Sandiford
- Joint Reconstruction Unit, Department of Orthopaedics, Southland Hospital, Invercargill, 9812, New Zealand.
- Department of Surgical Sciences, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
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Fink JM, Schreiner L, Marjanovic G, Erbacher G, Seifert GJ, Foeldi M, Bertsch T. Leg Volume in Patients with Lipoedema following Bariatric Surgery. Visc Med 2021; 37:206-211. [PMID: 34250078 PMCID: PMC8237786 DOI: 10.1159/000511044] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Lipoedema is characterized as subcutaneous lipohypertrophy in association with soft-tissue pain affecting female patients. Recently, the disease has undergone a paradigm shift departing from historic reiterations of defining lipoedema in terms of classic edema paired with the notion of weight loss-resistant leg volume towards an evidence-based, patient-centered approach. Although lipoedema is strongly associated with obesity, the effect of bariatric surgery on thigh volume and weight loss has not been explored. MATERIAL AND METHODS In a retrospective cohort study, thigh volume and weight loss of 31 patients with lipoedema were analyzed before and 10-18 and ≥19 months after sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Fourteen patients, with distal leg lymphoedema (i.e., with healthy thighs), who had undergone bariatric surgery served as controls. Statistical analysis was performed using a linear mixed-effects model adjusted for patient age and initial BMI. RESULTS Adjusted initial thigh volume in patients with lipoedema was 23,785.4 mL (95% confidence interval [CI] 22,316.6-25,254.1). Thigh volumes decreased significantly in lipoedema and control patients (baseline vs. 1st follow-up, p < 0.0001 and p = 0.0001; baseline vs. 2nd follow-up, p < 0.0001 and p = 0.0013). Adjusted thigh volume reduction amounted to 33.4 and 37.0% in the lipoedema and control groups at the 1st follow-up, and 30.4 and 34.7% at the 2nd follow-up, respectively (lipoedema vs. control p > 0.999 for both). SG and RYGB led to an equal reduction in leg volume (operation type × time, p = 0.83). Volume reduction was equally effective in obese and superobese patients (weight category × time, p = 0.43). CONCLUSION SG and RYGB lead to a significant thigh volume reduction in patients with lipoedema.
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Affiliation(s)
- Jodok M. Fink
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Lisa Schreiner
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg, Freiburg, Germany
- European Center for Lymphology Black Forest Germany, Specialist Clinic for Lymphology, Hinterzarten, Germany
| | - Goran Marjanovic
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Gabriele Erbacher
- European Center for Lymphology Black Forest Germany, Specialist Clinic for Lymphology, Hinterzarten, Germany
| | - Gabriel J. Seifert
- Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg, Freiburg, Germany
| | - Martha Foeldi
- European Center for Lymphology Black Forest Germany, Specialist Clinic for Lymphology, Hinterzarten, Germany
| | - Tobias Bertsch
- European Center for Lymphology Black Forest Germany, Specialist Clinic for Lymphology, Hinterzarten, Germany
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Georgiou I, Kruppa P, Schmidt J, Ghods M. Liposuction for Lipedema: Functional Therapy or Aesthetic Procedure? Aesthetic Plast Surg 2021; 45:212-3. [PMID: 32789540 DOI: 10.1007/s00266-020-01910-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
Liposuction is one of the most common procedures undertaken in plastic surgery with a steadily increasing trend over the years. Although usually performed as an aesthetic procedure for body contouring, it can also be utilized in specific patient groups for disease symptom reduction. One such disease entity is lipedema. The goal of this video to present the authors' technique in the surgical treatment of lipedema, and to offer the viewer a better understanding of the differences between an aesthetic liposuction and a functional liposuction as performed on a lipedema patient. Between July 2009 and July 2019, 106 lipedema patients have been treated in the authors' specialized lipedema clinic, with a total of 298 liposuction procedures and a median follow-up of 20 months. The mean amount of lipoaspirate was 6354.73 ml (± 2796.72 ml). The patients reported a significant reduction in lipedema-associated complaints and improvement in quality of life. The need for conservative therapy was significantly reduced. No serious complications were reported. The authors also present before and after photographs of three patients. 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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Di Renzo L, Cinelli G, Romano L, Zomparelli S, Lou De Santis G, Nocerino P, Bigioni G, Arsini L, Cenname G, Pujia A, Chiricolo G, De Lorenzo A. Potential Effects of a Modified Mediterranean Diet on Body Composition in Lipoedema. Nutrients 2021; 13:nu13020358. [PMID: 33504026 PMCID: PMC7911402 DOI: 10.3390/nu13020358] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/13/2022] Open
Abstract
Lipoedema is a subcutaneous adipose tissue disease characterized by the increase in the amount and structure of fat mass (FM) in specific areas, causing pain and discomfort. 95% of patients fail to lose weight in the lipoedema areas. The study was conducted to evaluate body composition and general health status modification in a group of lipoedema patients (LIPPY) and a control group (CTRL) after four weeks of a modified Mediterranean diet therapy (mMeD). A total of 29 subjects were included in the data analysis, divided in two groups: 14 LIPPY and 15 CTRL. After the mMeD, both groups significantly decreased their weight and body mass index; the CTRL also showed a reduction of all the circumferences and all FM’s compartments. LIPPY showed a decrease of FM in upper and lower limbs. No significant differences in Δ% between the groups were observed for the lean mass (LM). In LIPPY, an increase in the patients’ ability to perform various daily physical activities related to the loss of arms’ and legs’ fat was observed. According to the European Quality of Life scale, the possibility for LIPPY subjects to perform simple daily activities with less fatigue, pain and anxiety is highlighted. Further long-term studies are recommended to confirm the mMeD as a good strategy for Lipoedema treatment.
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Affiliation(s)
- Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (P.N.); (A.D.L.)
- Correspondence: ; Tel.: +39-349-805-2962
| | - Giulia Cinelli
- School of Specialization in Food Science, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (L.R.); (S.Z.); (G.L.D.S.)
- Predictive and Preventive Medicine Research Unit, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy
| | - Lorenzo Romano
- School of Specialization in Food Science, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (L.R.); (S.Z.); (G.L.D.S.)
| | - Samanta Zomparelli
- School of Specialization in Food Science, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (L.R.); (S.Z.); (G.L.D.S.)
| | - Gemma Lou De Santis
- School of Specialization in Food Science, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (L.R.); (S.Z.); (G.L.D.S.)
| | - Petronilla Nocerino
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (P.N.); (A.D.L.)
| | - Giulia Bigioni
- Department of Physics, University of Rome Sapienza, 00185 Rome, Italy; (G.B.); (L.A.)
| | - Lorenzo Arsini
- Department of Physics, University of Rome Sapienza, 00185 Rome, Italy; (G.B.); (L.A.)
| | - Giuseppe Cenname
- General Command of the Carabinieri, Health Department, 00197 Rome, Italy;
| | - Alberto Pujia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (A.P.); (G.C.)
| | - Gaetano Chiricolo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy; (A.P.); (G.C.)
| | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (P.N.); (A.D.L.)
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Elwell R, Rich A. Use of upper-limb compression garments in the management of lipoedema. Br J Community Nurs 2020; 25:S26-S27. [PMID: 33030376 DOI: 10.12968/bjcn.2020.25.sup10.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Compression hosiery is commonly used for the management of lymphoedema as well as lipoedema, but it is more commonly indicated for the lower limbs than for the upper limbs. The effects of compression hosiery on upper-limb lipoedema are poorly understood and researched. It is known that compression hosiery works in conjunction with activity or movement when standing or walking, which produces anti-inflammatory and oxygenating effects in the tissues. This effect is naturally difficult to realise in the upper limbs. Lymphoedema practitioners who treat those with lipoedema should bear in mind that compression treatment might not produce the same effects in upper-limb lipoedema as it does in lower-limb lipoedema. In these times of an overstretched health service, pragmatic resource use is essential.
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Affiliation(s)
- Rebecca Elwell
- Macmillan Lymphoedema Advanced Nurse Practitioner and Team Leader, University Hospitals of North Midlands NHS Trust; British Lymphology Society Trustee
| | - Anna Rich
- Clinical Nurse Specialist/Team Leader Lymphoedema, Lymphoedema Clinic, University Hospitals of Derby and Burton NHS Foundation Trust
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Forner Cordero I, López Martin M, Reina Gutiérrez L, Belmonte R, Ruiz Miñarro R, Crespo Cobo MP, Pardo Sievers B, Pujol Blaya V, De Miguel Benadiba C, Puigdellivol C. [Management of patients with lymphatic diseases and lipoedema during the COVID-19 pandemic. Recommendations of the Spanish Group of Lymphology]. Rehabilitacion (Madr) 2020; 54:276-283. [PMID: 32863012 PMCID: PMC7414319 DOI: 10.1016/j.rh.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/23/2020] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic poses a challenge to the management of non-COVID pathologies such as lymphatic diseases and lipoedema. The use of telemedicine can prevent the spread of the disease. A system is needed to help determine the clinical priority and selection of face-to-face or telemedicine options for each patient and how to carry them out during the pandemic. The Spanish Lymphology Group has drafted a consensus document with recommendations based on the literature and clinical experience, as clinical practice guidelines for the management of lymphatic abnormalities and lipoedema during the COVID-19 pandemic. These recommendations must be adapted to the characteristics of each patient, the local conditions of the centres, and the decisions of health care professionals. The document contains minimum criteria, subject to modifications according to the evolution of the pandemic, scientific knowledge and instructions from health authorities.
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Affiliation(s)
- I Forner Cordero
- Unidad de Linfedema, Servicio de Medicina Física y Rehabilitación, Hospital Universitari i Politècnic La Fe, Universitat de Valencia, Valencia, España.
| | - M López Martin
- Unidad de Linfedema, Servicio Rehabilitación y Medicina Física, Hospital Universitario de la Princesa, Madrid, España
| | - L Reina Gutiérrez
- Servicio de Angiología y Cirugía Vascular, Hospital Central de la Cruz Roja, Madrid, España
| | - R Belmonte
- Medicina Física i Rehabilitació Parc de Salut Mar, Barcelona, Universitat Autònoma de Barcelona, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España
| | - R Ruiz Miñarro
- Unidad de Linfedema, Clínica Salut i Esport, Barcelona, España
| | - M P Crespo Cobo
- Unidad de Linfedema, Hospital Universitario Gregorio Marañón, Madrid, España
| | - B Pardo Sievers
- Servicio de Fisioterapia, Hospital Clínico Universitario de Valencia, Valencia, España
| | - V Pujol Blaya
- Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, España
| | | | - C Puigdellivol
- Unidad de Flebología y Linfología. Instituto Cardiovascular Teknon. Hospital Quiron -Teknon, Barcelona, España
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13
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Abstract
Lipoedema is an incurable chronic disease causing limb deformity, painful skin and excessive ecchymosis. Compression garments are frequently recommended to manage symptoms, but the existing products are not designed specifically for lipoedema, and are for other medical conditions. A structured questionnaire was prepared in Online Surveys in October 2018 to investigate lipoedema symptoms and the use of compression garments to manage them. Some 279 people with lipoedema completed the survey; 70% wore compression garments in all four compression classes, of which class 2 was most common (58% of wearers). The top three reasons for wearing compression garments were to feel supported (73%), reduce lipoedema pain (67%) and improve mobility (54%). Most people with lipoedema who wore compression garments found compression helpful in managing their symptoms, but overall satisfaction was low. Problems with existing compression garments were so severe in some cases that the garments were not worn at all or used less often. The information collected in this survey might be useful for the design and development of compression garments specifically for lipoedema.
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Affiliation(s)
| | - Lisa Macintyre
- Principle Investigator, both at the School of Textiles and Design, Heriot-Watt University, Netherdale, Scotland
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14
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Abstract
Lipoedema, an adipose tissue disorder, is a poorly visible, often unrecognised condition. To foster a greater understanding of the significant and debilitating impacts faced by women living with lipoedema, the charity Lipoedema UK conducted four focus group interviews, the findings of which were published in a series of reports under the umbrella title 'Women in dire need'. The reports identified the substantial and numerous negative effects of lipoedema on the women's everyday lives, including the patients' experiences with compression garments, the effects of liposuction surgery (many of which were not positive), the everyday impacts ranging from pain and reduced mobility to poor self-esteem and working prospects, and the considerable challenges faced by women with late-stage lipoedema which can render them immobile.
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Affiliation(s)
- Amy Fetzer
- Editorial consultant, Lipoedema UK; Freelance journalist and consultant specialising in health and sustainability
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15
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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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16
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Romeijn JRM, de Rooij MJM, Janssen L, Martens H. Exploration of Patient Characteristics and Quality of Life in Patients with Lipoedema Using a Survey. Dermatol Ther (Heidelb) 2018; 8:303-11. [PMID: 29748843 DOI: 10.1007/s13555-018-0241-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Lipoedema is a chronic disorder in which excessive fat distribution occurs predominantly from the waist down, resulting in a disproportion between the lower extremities and upper torso. Lipoedema is often not recognized, while patients experience pain and easy bruising. As a long-term condition, lipoedema has a massive effect on patients' lives and mental health. The aim of this study is to explore patient characteristics, quality of life, physical complaints and comorbidities in patients with lipoedema. METHODS A survey was conducted by email amongst lipoedema patients, consisting of informed consent and multiple questionnaires. The questionnaires included general patient characteristics, physical complaints, comorbidities, RAND-36 and EQ-5D-3L. Participants who responded to a message on the Dutch Lipoedema Association website were recruited. RESULTS All lipoedema patients experience physical complaints, with pain (88.3 %) and easy bruising (85.9 %) as primary complaints. The diagnosis was mostly made by a dermatologist after visiting a mean of 2.8 doctors. Furthermore, mean time from onset until diagnosis was 18 years. Quality of life (59.3) was significantly lower than the Dutch female average (74.9; p < 0.001). Additionally, patients with comorbidities had significant lower quality of life (RAND 54.7, p < 0.001). CONCLUSIONS Lipoedema patients often have severe complaints and experience lower quality of life regarding physical, emotional and social functioning. Additionally, comorbidities have a large impact on quality of life.
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17
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Dadras M, Mallinger PJ, Corterier CC, Theodosiadi S, Ghods M. Liposuction in the Treatment of Lipedema: A Longitudinal Study. Arch Plast Surg 2017; 44:324-31. [PMID: 28728329 DOI: 10.5999/aps.2017.44.4.324] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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18
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Greene A, Meskell P. The impact of lower limb chronic oedema on patients' quality of life. Int Wound J 2017; 14:561-568. [PMID: 27489034 PMCID: PMC7949854 DOI: 10.1111/iwj.12648] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 06/23/2016] [Accepted: 06/27/2016] [Indexed: 11/28/2022] Open
Abstract
This study aimed to explore patients' perceptions regarding the impact that lower limb chronic oedema has on their quality of life (QoL). A quantitative descriptive design was used to collect data from patients with lower limb chronic oedema. A condition-specific validated questionnaire was distributed to a purposive sample (n = 122) through manual lymphatic drainage/vascular/health clinics in Ireland. Results indicated that patients with lower limb chronic oedema experience a wide range of physical problems such as limb heaviness (74%, n = 66), weakness (44%, n = 40) and pain (38%, n = 34). Additionally, difficulties with walking (53%, n = 48), standing (51%, n = 46) and bending (45%, n = 40) were reported. Concerns regarding poor body image were strongly evident (76%, n = 68). Difficulties finding clothing/footwear to fit oedematous limb(s) were reported (59%, n = 53), in addition to finding clothes that participants would like to wear (64%, n = 58). Emotional symptoms of irritability (42%, n = 38), anxiety (41%, n = 37) and tension (40%, n = 36) were reported. Over half of the participants (55%, n = 49) stated that their chronic swelling affected their social functioning and their ability to engage in leisure activities. This study has identified that lower limb chronic oedema has significant psychological, social and physical implications for persons' QoL.
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Affiliation(s)
- Adelene Greene
- Tissue Viability DepartmentUniversity Hospital GalwayGalwayIreland
| | - Pauline Meskell
- School of Nursing & MidwiferyNational University of IrelandGalwayIreland
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19
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Abstract
At present, there is no proven cure for lipoedema. Nevertheless, much can be done to help improve symptoms and prevent progression. Many of these improvements can be achieved by patients using self-management techniques. This article describes the range of self-management techniques that community nurses can discuss with patients, including healthy eating, low-impact exercise, compression garments, self-lymphatic drainage, and counselling.
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Affiliation(s)
- Amy Fetzer
- Freelance Journalist and Consultant Specialising in Health and Sustainability
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20
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Abstract
Frequently misdiagnosed as obesity, lipoedema is chronic condition involving an abnormal build-up of fat cells in the legs, thighs and buttocks that cannot be shifted by exercise or dieting. Estimated to affect up to 11% of the female population, the condition is widely unknown by health professionals. This means women typically wait for many years before diagnosis. This allows the condition to progress unchecked, resulting in unnecessary deterioration and the development of associated comorbidities, as well as significant pain and mental anguish. A free, 30-minute Royal College of General Practitioners (RCGP) e-learning course created in partnership with Lipoedema UK aims to rectify this situation by educating nurses, GPs and other health professionals on how to diagnose and manage lipoedema in primary care. This article aims to describe the condition of lipoedema, how to recognise/diagnose it, current treatment options and the findings of a 240-patient survey carried out by Lipoedema UK in 2013 that included documenting the difficulties for patients in obtaining a diagnosis as well as the mental and physical effects of the condition.
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Affiliation(s)
- Amy Fetzer
- Freelance journalist and consultant specialising in health and sustainability
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