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Introduction: In the scientific literature complaints in patients with lipoedema are described as pain due to pressure or as tenderness. Objective: To better classify the quality of pain in lipoedema and to find out about the extent of complaints. Methods: 50 patients with lipoedema stage II received a questionnaire with 30 items containing adjectives of sensory and affective pain qualities. For these items they could choose between »fits exactly«, »fits fairly well«, »fits little« or »does not fit«. In addition, patients were asked to describe their complaints with their own words. Results: In most cases the items pressing and lumpish were chosen. Many patients used the characterizations heavy, tearing, distressing, enervating, fierce, unbearable, exhausting, and pinching. The median values of all the patients´ sensory and affective scores showed – compared to people with chronic pain – »average« values. However, by using their own words, the complaints were often described as extremely burdensome. Conclusion: For describing pain in lipoedema only few items were used by the patients. There were great interindividual variations. Aspects of pain can be quite burdensome; they should be used in the characterization and the grading of lipoedema. Key words: lipedema, pain assessment, pain experience scale

Lipedemawas first described by Allen and Hines in 1940 (1).Today, however, a large number of physicians remain unaware of the disease and its symptoms. Many lipedema patients are not correctly diagnosed or effectively treated until after they have endured decades of suffering (2). Epidemiological statistics on the incidence of lipedema are not available. An investigation of patients treated at one lymphedema clinic from 1995 to 1996 revealed lipedema in approximately 15% of the patients treated on an inpatient basis (3). A similar number (8% to 17%) was reported in surveys carried out in 2003 in four lymphedema clinics in Germany (4). In contrast to lymphedema, literature on lipedema is extremely sparse. Lipedema findings in the Anglo-American literature in particular often report only isolated case studies (5-8). Many more publications, including a monograph, are available in German literature (9). Table 7-1 lists synonyms for lipedema.

Fluorescence microlymphography (FML) is an almost atraumatic technique used to visualize the superficial skin network of initial lymphatics through the intact skin of man. Visualization was performed with an incident light fluorescence microscope following subepidermal injection of minute amounts of FITC-dextran 150,000 using microneedles. Emanating from the bright dye depot, the surrounding network of microvessels is filled, documentation performed by photography or video film. In congenital Milroy lymphedema, a lack of microlymphatics (aplasia) is typical while in other primary lymphedemas and in secondary lymphedema after mastectomy or irradiation of proximal lymph nodes, the network remains intact but the depicted area is enlarged. Lymphatic microangiopathy characterized by obliterations of capillary meshes or mesh segments develops in phleboedema with trophic skin changes, progressive systemic sclerosis and Fabry's disease. In lipedema, lymphatic microaneurysms are stained. Microlymphatic pressure may also be measured using FML. For this purpose, glass micropipettes are inserted into the capillaries by means of a micromanipulator and pressure is determined by the servo-nulling technique. Normal subjects produced significantly lower pressure (7.9 +/- 3.4 mmHg) compared to patients with primary lymphedema (15.0 +/- 5.1 mmHg, p<0.001). This characteristic lymphatic hypertension may be improved by complex physiotherapy or local application of prostaglandins. Additionally, a modification of the FML procedure can be used to measure lymphatic capillary flow velocity in controls and patients. FML is suited to confirm the clinical diagnosis of lymphedema, contributes to distinguish among various forms of edema, and is useful in clinical research. In addition, FML has also become a tool for experimental animal studies including the depiction of gastric microlymphatics, the measurement of flow velocity in the naked mouse tail, and in evaluation of lymphangiogenesis in a model of Milroy disease.

In 10 patients, lymphatic drainage was studied before and after liposuction of the legs, employing dynamic lymph scintigraphy. The data (comparison of right/left, stress/rest, before/after liposuction) were well reproducible. Lymphatic drainage was not altered significantly after liposuction as compared to the pretherapeutic status. Particularly, no relevant disturbance of lymphatic drainage became evident. Our limited data indicate that liposuction does not cause relevant damage to lymph vessels.

he term “lipedema“ was first used in 1974 by ALLEN and HINES. Their publication is regarded as “the classical description“ of the syndrome5; p. 184: “We wish to describe a clinical syndrome, lipedema of the legs, which is frequently very distressing. In our experience it affects solely women. The chief complaint is of swelling of the legs and feet...On questioning, the physician may elicit that enlargement of the limbs has always been generalized and symmetrical. The swelling below the knees is accentuated when patients are on their feet much and in warm weather. Aching distress in the legs is common... Occasionally, a patient feels, that her large legs have ‘ruined her life.’ Many are ‘ashamed’ of their legs.” This describes the patient’s problems very well, but it is difficult to define lipedema precisely because the definition depends mainly on subjective findings. There are no medical or laboratory tests to distinguish local lipohypertrophy (local fat tissue increase) of the legs or hips from lipedema or general obesity. Consequently, lipedema is not generally accepted as a real disease. We will attempt to describe the current knowledge on the pathophysiology and treatment of lipedema. Lipedema is a metabolic disorder of the adipose (fat) tissue with unknown etiology, affecting almost exclusively females. The following clinical and pathophysiological findings are of importance for differential diagnosis.

This case presentation illustrates the tremendous functional gains that individuals with lipo-lymphedema can achieve with proper diagnosis, education and treatment.

After successful completion of a conservative initial treatment consisting of manual lymph drainage and bandaging a lipedema must be fitted with an adequate compression garment made of flat-knitted material.The type of the compression supply and its duration following liposuction depends on the result obtained after the removal of fatty tissue. Due to liposuction alone, an improvement of the quality of life can be already achieved. An additional treatment using compression garments may have a positive effect, too.

Compiled by an internationally renowned pioneer in the field of lymphology with contributions from leading experts, this textbook explores all aspects of lymphological science, including the causes, diagnoses, prognoses, and treatments for primary and secondary Lymphedema. Comprehensive discussions address all the essential topics relevant to lymphology, such as anatomy, physiology, and pathophysiology. Therapists will benefit from practical information on clinical findings as well as instructions for performing manual lymph drainage.Provides a detailed presentation of the anatomy and physiology of the lymphatic system.Explores the causes, diagnoses, therapies and prognoses of all lymphological conditions from a physician's perspective.Includes a well-founded and practical discussion on the techniques, effects and implementation of Complete Decongestive Therapy (CDT).

The primary lymphedema is a pathological interstitial accumulation of lymphatic fluid. Lower limbs are mainly affected by primary lymphedema. It is caused by a hereditary lack or complete absence of lymphatic vessel systeme. Final complications of chronic limb lymphedema include »elephantiasis«, lymphatic ulceration and malignant degeneration. Secondary lymphedema, obesity, phlebedema and lipedema are most important differential diagnoses.Treatment of primary lymphedema includes early manual lymph drainages, decrease in weight, exercise, prevention or therapy of skin infections. Up to the present primary lymhedema cannot be cured in causality.

Lipoedema: Improved Quality of Life by Combination of Therapies Lipoedema is a chronic progressive disease with increased fat volumes mainly of the legs, causing body disproportion together with orthostatic oedema, pain and bruising. Early diagnosis can be achieved by clinical symptoms. Complex physical therapy with manual lymphatic drainage, compression and physiotherapy reduces oedema and complaints. Surgical therapy with liposuction reduces circumscribed fat volumes, improves body proportions and diminishes oedema and bruising. Following surgery physical therapy can be diminished in intensity and number. Nowadays the combination of physiotherapy and liposuction is considered the optimal treatment regime which can tremendously improve the patient's quality of life.