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Einleitung: Bei einem Lipödem liegt eine anlagebedingte Fettgewebsvermehrung vor, bei der es zu einer symmetrischen Verdickung der Extremitäten kommt. Klinisch ist für das Lipödem eine Druckschmerzhaftigkeit charakteristisch. Bei länger bestehendem Lipödem kann man beobachten, dass bei einem Teil der Patientinnen zusätzliche Beschwerden auftreten. Die betroffenen Frauen erleben auf Grund der massiven Schwellungen dann, neben einem ausgeprägten Spannungs- und Schweregefühl der Beine, physische und psychische Belastungen, wodurch Sportangebote häufig nicht wahrgenommen werden und die soziale Interaktionen eingeschränkt ist. Studiendesign: Die vorliegende prospektive randomisierte Studie wurde zur Evaluation der Wirksamkeit eines vibrationsgestützten Krafttrainings mit dem Galileo-System im Vergleich zu einem herkömmlichen Training zur Aktivierung der Beinmuskelpumpe bei Patientinnen mit Lipödem durchgeführt. Die Probanden beider Gruppen erhielten 12 Anwendungen in einem Zeitraum von sechs Wochen. Zur Beurteilung des Therapieverlaufs wurde die Druckschmerzschwelle im Beinbereich mithilfe der visuellen Analogskala (VAS) und der Dolorimetrie an definierten Messpunkten erfasst. Nebenzielkriterien waren die Volumenreduktion und die Verbesserung funktioneller Parameter sowie der Lebensqualität. Die Erhebung der Outcomeparameter erfolgte vor der Intervention (U1), vor der letzen Trainingseinheit (U2) und 6 Wochen nach Therapieende (U3). Ergebnisse: Das Vibrationstraining (n=27) und die Venengymnastik (n=17) zeigten bezüglich der Schmerzlinderung signifikante Verbesserungen im Therapieverlauf. Die Druckschmerzschwelle konnte erhöht werden. Die Auswertung der Fragebögen zu Hämatomneigung und Schmerzempfinden ergab in der Interventionsgruppe eine signifikante Beschwerdelinderung im Therapieverlauf. In beiden Gruppen konnte eine subjektive Verbesserung der Mobilität und ein positiver Einfluss auf die Lebensstiländerung verzeichnet werden. Die im Gehtest beurteilte Ausdauerleistung verbesserte sich ebenfalls. Diskussion: Es konnte gezeigt werden, dass sowohl mit herkömmlicher Krankengymnastik als auch durch ein gerätegestütztes Vibrationstraining zwei wesentliche Symptome des Lipödems, nämlich Druckschmerzhaftigkeit und Hämatomneigung, positiv beeinflusst werden können. Somit lässt sich die Notwendigkeit unterstreichen, dass eine Therapie des Lipödems durch eine Bewegungstherapie ergänzt werden sollte.

Lipofibromatosis is a slow-growing, childhood soft-tissue neoplasm that is often confused with other conditions. We report a patient with lipofibromatosis causing extremity enlargement at birth. The lesion initially was thought to be a vascular anomaly or lipedema on clinical and MRI examination. When involving the lower extremity, diffuse lipofibromatosis must be differentiated from more common causes of lower limb enlargement in children: lymphatic malformation, lymphedema, or lipedema. Compared with these more frequent conditions, lipofibromatosis usually causes less morbidity. Management of the tumor includes observation or excision. Because complete extirpation of the lesion is difficult, the recurrence rate is high.

OBJECTIVE: To assess for the first time the morphology of the lymphatic system in patients with lipedema and lipo-lymphedema of the lower extremities by MR lymphangiography. MATERIALS AND METHODS: 26 lower extremities in 13 consecutive patients (5 lipedema, 8 lipo-lymphedema) were examined by MR lymphangiography. 18 mL of gadoteridol and 1 mL of mepivacainhydrochloride 1% were subdivided into 10 portions and injected intracutaneously in the forefoot. MR imaging was performed with a 1.5-T system equipped with high-performance gradients. For MR lymphangiography, a 3D-spoiled gradient-echo sequence was used. For evaluation of the lymphedema a heavily T2-weighted 3D-TSE sequence was performed. RESULTS: In all 16 lower extremities (100%) with lipo-lymphedema, high signal intensity areas in the epifascial region could be detected on the 3D-TSE sequence. In the 16 examined lower extremities with lipo-lymphedema, 8 lower legs and 3 upper legs demonstrated enlarged lymphatic vessels up to a diameter of 3 mm. In two lower legs with lipo-lymphedema, an area of dermal back-flow was seen, indicating lymphatic outflow obstruction. In the 10 examined lower extremities with clinically pure lipedema, 4 lower legs and 2 upper legs demonstrated enlarged lymphatic vessels up to a diameter of 2 mm, indicating a subclinical status of lymphedema. In all examined extremities, the inguinal lymph nodes demonstrated a contrast material enhancement in the first image acquisition 15 min after injection. CONCLUSION: MR lymphangiography is a safe and accurate minimal-invasive imaging modality for the evaluation of the lymphatic circulation in patients with lipedema and lipo-lymphedema of the lower extremities. If the extent of lymphatic involvement is unclear at the initial clinical examination or requires a better definition for optimal therapeutic planning, MR lymphangiography is able to identify the anatomic and physiological derangements and to establish an objective baseline.

A lipedema is characterized by the bilateral and symmetrical en-largement of the lower limbs without the involvement of the feet and a negative Stemmer’s sign; it may cause skin hypothermia, alteration in the plantar support, and hyperalgesia. The current study aims to report a rare type of ulcerative lesion in a patient with lipolymphedema treated with a damp low-stretch bandage. The patient is a female, age 50, with a family history of lipedema, and who has suffered many episodes of erysipelas in the lower left limb for approximately 20 years. For over five years ulcers which are difficult to heal have appeared. She was treated with a damp low-stretch bandage and the healing of the wound has shown significant improvement. Ulcerative lesions are rare in lipolymphedema; however, their occurrence is associated with difficulties in healing.

Lipoedema is a fat distribution disorder causing massive, bilaterally symmetrical enlargement of the lower and in some cases the upper extremities in women. The atraumatic, anatomically appropriate procedure of water jet-assisted liposuction available today represents a promising treatment for these patients who generally suffer from severe subjective and objective impairment. Liposuction treatment can bring long-term improvement if the operative technique focuses on lymph vessel preservation. Immunohistologic analyses show minimal evidence of lymph vessel structures in lipoaspirates. The histologic analysis of the aspirates documents a relatively specific removal ("apheresis") of primarily intact lipocytes with low vascular amount.

BACKGROUND Many surgeons consider liposuction using tumescent local anesthesia (TLA) to be a safe technique, but when TLA has been combined with other techniques, such as general anesthesia or intravenous medication, or when the guidelines associated with TLA have been violated, serious complications and deaths have occurred. This has resulted in uncertainty concerning the safety of liposuction using TLA, which this article seeks to resolve. OBJECTIVE To investigate whether liposuction using TLA is a safe procedure. METHODS The same surgeon performed liposuction using exclusively TLA in 3,240 procedures. Detailed records were kept of the complications that occurred. RESULTS In a series of 3,240 procedures, no deaths occurred, and no complications requiring hospitalization were experienced. In nine cases, complications developed that needed further action. CONCLUSIONS Liposuction using exclusively TLA is a proven safe procedure provided that the existing guidelines are meticulously followed.

Lipoedema is a disease of women, characterised by a circumscribed accumulation of subcutaneous fat, mainly in the legs, with oedema, hematomas, and pain from tension and pressure. Up to now, only conservative treatment with manual lymphatic drainage and compression was possible. Nowadays surgical therapy with liposuction under tumescent local anaesthesia can not only improve morphology but can also reduce complaints. When performed with modern techniques by experienced surgeons, liposuction is very safe and highly effective. The combination of conservative and surgical methods can considerably improve quality of life.

Lymphoedema is a clinical manifestation of an impaired lymphatic drainage with accumulation of lymphatic fluid. Lipoedema is characterized by bilateral enlargement of the legs and/or arms due to abnormal deposition of fatty tissue, which accumulates fluid. Conservative treatment including compressions garments and lymphatic drainage is suitable to prevent ongoing clinical deterioration although both diseases cannot be cured. The ability to properly diagnose lymphoedema and lipoedema is crucial to prevent the significant morbidity and loss of quality of life that is associated with this condition. It is imperative that patients with lymphoedema are referred to specially trained healthcare professionals to ensure optimal treatment. Continuous therapy with strict compliance of the patients is essential, and premature interruption is the most frequent mistake. Lipoedema is a different entity but patients are still fighting for acceptance. The mutual relation of lipoedema and obesity and the poor knowledge of the underlying mechanisms limit the acceptance of lipoedema as a relevant disease.

The population of morbidly obese patients, along with the incidence of lymphedema and massive localized lymphedema associated with this condition, is increasing. A 5-year retrospective review of data (2000-2005) shows that the percentage of patients >350 lb in the authors' clinic population increased from approximately 7% to 11% and 75% of their morbidly obese patients (body mass index >40) had or have lymphedema. After a differential diagnosis between lipedema and lymphedema (primary or secondary) has been made, lymphedema management options include compression bandaging, manual lymphatic drainage, and localized surgeries. The treatment of morbidly obese lymphedema patients requires additional staff time and specialized equipment to move or position them and may be confounded by other conditions (eg, heart failure and venous insufficiency) that contribute to edema. Lymphedema treatments have been found to be useful, providing patients are able to follow treatment guidelines, especially with regard to weight control. In the authors' experience, massive localized lymphedema will recur unless the primary issue of obesity is addressed. Establishing clear criteria and patient participation guidelines before initiating a comprehensive localized lymphedema program will improve outcomes.

Lymphatic disease is quite prevalent, and often not well clinically characterized. Beyond lymphedema, there is a broad array of human disease that directly or indirectly alters lymphatic structure and function. The symptomatic and objective presentation of these patients can be quite diverse. In this review, we have attempted to provide a systematic overview of the subjective and objective spectrum of lymphatic disease, with consideration of all of the categories of disease that primarily or secondarily impair the functional integrity of the lymphatic system. Lymphedema is discussed, along with chromosomal disorders, lymphangioma, infectious diseases, lymphangioleiomyomatosis, lipedema, heritable genetic disorders, complex vascular malformations, protein-losing enteropathy, and intestinal lymphangiectasia.

Introduction: Complaints of lipoedema are mainly referred to as pressure pain or tension in the scientific literature. Objective: The objective was to enable a further differentiation of the quality of the perceived discomfort and provide a preliminary quantification of pain severity. Methods: 50 patients with Stage II lipoedema were asked to complete a questionnaire containing 30 items corresponding to sensory and affective pain sensations. For these items, they could choose between “completely applicable”, “largely applicable”, “somewhat applicable”, or “not applicable”. The patients were also asked to describe their complaints in their own words. Results: The items pressing and dull were specified most frequently. The following were indicated to a lesser extent: severe, tearing, nagging, unnerving, fierce, unbearable, exhausting, and sharp. Compared to patients with chronic pain, the mean values of all the patients’ sensory and affective scores yielded an average pain severity. However, when the patients used their own formulations, the complaints were often described as being very pronounced. Conclusion: Only a small portion of the adjectives offered was suitable for characterising the sensations of lipoedema. There were considerable inter-individual variations in how the pain was perceived. The severe symptoms, which are partially subjective, should be considered when characterising lipoedema.

Lipedema is characterized by symmetric lower extremity enlargement secondary to the deposition of fat. Lipedema is not rare, but it is commonly misdiagnosed as lymphedema. We describe a 20-year-old woman with massive lower extremity enlargement that did not respond to compression therapy. Magnetic resonance imaging of the lower extremities helped to confirm the diagnosis.

Lipoedema: a new therapy regimen b Lipoedema, a disease in women, is characterised by circumscribed accumulation of subcutaneous fat, mainly in the legs, with oedema, tension pain, tenderness and haematomas.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Discuss the initial evaluation of a patient presenting with lower extremity enlargement. 2. Distinguish underlying medical conditions causing lower extremity enlargement, including lymphedema and lipedema. 3. Discuss appropriate management and treatment for patients presenting with these conditions. BACKGROUND: Given the epidemic of obesity in the United States, many patients will consult the plastic surgeon with complaints of lower extremity enlargement secondary to "fat legs." In addition to cosmetic disfigurement, some patients may suffer from underlying medical conditions that are responsible for their symptoms. Knowledge of these other causes, including lymphedema and a disorder of abnormal fat deposition known as lipedema, ensures appropriate management and/or surgical treatment for affected patients. METHODS: Initial evaluation for lower extremity enlargement should include a discussion of pertinent medical history and a focused physical examination for findings that might indicate a pathologic underlying cause. When indicated, patients should undergo additional testing, including radiologic studies, to confirm their diagnoses. RESULTS: For those patients found to have lymphatic dysfunction, conservative management, such as massage therapy, use of compression garments, and limb elevation, should be initially recommended. Excisional or suction-assisted lipectomy may be considered in patients who fail conservative therapy. More extensive consultation with the plastic surgeon is recommended for patients seeking aesthetic improvement in contour and shape of large legs without a specified underlying abnormality. CONCLUSIONS: Patients with lower extremity enlargement may present to the plastic surgeon unsure of the specific cause of their deformity. A broad differential diagnosis exists for their presentation, which can be narrowed by using the common features and unique manifestations of the conditions.

Surgical approaches are usually not part of the strand rad approach in lymphologic therapy. Classic therapy is conservative and controls symptoms rather than seeking cures. Plastic surgical tissue reduction results in impaired lymph flow in many cases. Improving the lymphologic disease while reducing the need for complex compression therapy are major therapeutic goals. Lymphologic liposculpture offers a successful way to treat lipohyperplasia dolorosa and offers a new concept in the treatment of secondary lymphedema.