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Lipodystrophy, almost exclusively seen in female patients, causes psychological problems at an early age. In later life, additional complaints are heavy painful legs, edema, and varicose veins. Nearly all patients suffer from alimentary adiposity. Dermolipectomies in general are not advisable because of the resulting large scars and the risk of damaging the lymphatic system. Subcutaneous lipectomy according to the Illouz method can provide good results. Weight loss is a good alternative to liposuction of the upper legs. After sufficient weight loss, only additional liposuction of the trochanteric area and the medial side of the knee is needed. No unpleasant scarring of the leg results. Unfortunately, older patients often require a skin reduction. The results of surgery in the lower legs were, except in 2 patients, good to excellent. The results in the upper legs were disappointing because 9 of 11 patients gained weight again after surgery. Considering this, the preferable treatment now is liposuction of the lower legs, medial side of the knee, and the txochanteric area. Only in cases of ptotic skin on the medial side of the upper legs is skin reduction without lipectomy indicated. Lipodystrophy suggests a disappearance of the subcutaneous fat. When this occurs in the upper part of the body, it is called progressive lipodystrophy. Lipodystrophy is known as an abnormality of the lower half of the female body, swollen by deposition of subcutaneous fat and determined by heredity. It occurs more frequently in the lower social classes and is often accompanied by an alimentary obesity, which is a psychological reaction to the disturbed body image. Nearly all patients have severe feelings of inferiority because people mock and laugh at them; thus, the alimentary component of the obesity is a form of compensation for lack of love. By dieting, the adiposity disappears only partly because the typical deformity of lipodystrophy remains. I believe that in the lipodystrophy patient a lipedema may develop resulting from lymphatic and venous disease, which may arise later in life. Younger patients' complaints are mainly psychological and result from a disturbed body image, whereas older patients are troubled by pain and leg weariness. Treatment consists of dieting, subcutaneous lipectomy by liposuction, and prescription of elastic stockings.

An elderly patient with a swollen leg or legs can present a challenging problem in differential diagnosis. Although most swollen legs are the result of congestive heart failure, thrombophlebitis, cellulitis, or lymphedema, many other conditions should also be considered.

Lipedema is a common disease in the usual clinical practice. None organic description about the clinical symptoms and signs associated to this condition has been published. Fifty women with lipedema have been examined by the authors, and incidence rates of symptoms and signs have been emphasized. The following signs and symptoms were constantly reported: "Egyptian column", elastic edema, negative Stemmer's sign, alterated plantar support, cutaneous hypothermia. Some others were frequently found: ecchymosis, spontaneous pain, liposclerosis on the thigh, hypodermic hyperalgesia and pain on the internal face of the knee. Moreover, the two most relevant differential diagnosis as well as their two variant's clinical features (mixed lipedema and "thin women" lipedema) have been described.

Lipedema is a hereditary disease concerning exclusively women. We discuss the characteristics of diagnosis as well as the differential diagnosis between lipedema and primary lymphedema. Therapy is effective if the lipedema resembles a lymphedema.

Two cases of lipedema are presented. They illustrate this clinical syndrome which occurs almost exclusively in women and presents as grossly enlarged legs, thighs and buttocks. The etiology remains uncertain. Although infrequently diagnosed, lipedema is not rare. We report success treating such patients with properly measured and fitted compression garments.

La classification des lymphoedèmes en diverses catégories étiologiques est importante autant pour le diagnostic que pour un programme thérapeutique correct. L'approche diagnostique idéale doit Par conséquent envisager toutes les conditions, autant congénitales qu'acquises, responsables de la perturbation de la circulation lymphatique. Dans toutes les formes l'anamnèse est d'intérêt fondamental pour arriver au diagnostic étiologique alors qdu' e l'exame n c1 m· 1· que su ffii t a· poser le si·m ple iagnostic de lymphoedème.

Lipedema of the legs is a symmetrical thickening of upper and lower leg and topically accentuated fat pads. The back of the foot is usually free of swelling. Pathogenetically it is a disturbance of the distribution pattern of subcutaneous fat tissue. Epidemiologically, the subjects affected are women, starting from puberty. Weight reduction programs do not influence the real deformations. If this abnormal fat tissue is infiltrated by angiological diseases, these manifest themselves in modified form. In particular, all the symptoms are more painful. In arterial ischemic syndromes that taut skin is susceptible to necrosis at atypical locations. For reconstruction of trunk arteries it is advisable to bypass larger bulges for better wound nealing. Venous strips should be peeled out away from fat pads and venous-bridges very carefully to protect the tissue. Acute and chronic phlebothrombosis lead to unusual and asymmetrical forms of swelling. The venous ulcer lies directly beneath a fat-muff in the gaiter region. Since they are hard to compress, free skin transplants should be considered early in the course of development. Surgery of varicose veins calls for most careful technique to ensure wound healing. From the lymphological viewpoint there are clinically and lymphographically mixed forms of lymphedema with lipedema.

This condition, which has the full name of 'erythrocyanosis frigida crurum puella rum' (cold reddish blueness of the legs of girls), is extremely common. It is not always recognized, being misdiagnosed as lymphoedema, vasomotor disease, arterial insufficiency, and other things. The skin of the legs is cold to the touch and exhibits patches of bluish discoloration. There may be chilblains and small superficial ulcerated areas. There is often an abnormally large amount of fat particularly above the ankle and around the tendo Achillis. For this reason it is sometimes called ' lipoedema'. The affected patches are often hypersensitive to light touch and may irritate with changes of temperature. Deeper palpation may reveal tenderness and nodularity of the underlying fat. The condition is usually symmetrical or alsmost so. The feet often remain normal. At typical case is illustrated in Figs. 14.22 and 14.23

Systemic causes of leg edema include idiopathic cyclic edema, heart failure, cirrhosis, nephrosis and other hypoproteinemic states. Lymphedema may be primary, or secondary to neoplasm, lymphangitis, retroperitoneal fibrosis and, rarely (in the U.S.), filariasis. Thrombophlebitis and chronic venous insufficiency are not uncommon causes. Finally, infection, ischemia, lipedema, vascular anomalies, tumors and trauma can be responsible for the swollen leg.