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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.

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.

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.

OBJECTIVE: Many investigations and treatments exist for lower limb lymphoedema. We undertook a survey on the management of this condition by vascular surgeons and the resources available for its treatment in the UK. DESIGN: A questionnaire was designed to assess the management of lymphoedema. MATERIALS AND METHOD: A postal questionnaire was sent to all members of the The Vascular Society of Great Britain and Ireland. RESULTS: 251/440 (57%) consultant surgeons returned a completed questionnaire comprising 45.3% teaching hospital and 54.7% district general hospital (DGH) consultants. 77.9% of the consultants saw less than 10 patients annually with lymphoedema. The commonest causes of lymphoedema were primary lymphoedema (99.3%) and malignancy (37.1%). Lipoedema, a cause of limb swelling was only seen or recognised by 46.2% of the consultants. The commonest investigations performed were a duplex scan, lymphoscintigram, full blood count and urea and electrolytes. The common methods of confirming lymphoedema were either by lymphoscintigram (54.5%) or from a diagnosis of exclusion (33.7%). Lymphoedema physiotherapy was available only to 53.8% of the consultants. Surgery was performed by 10.5% of consultants. 73.4% of the consultants believed that lymphoedema is managed inadequately and 72.9% believed that resources are insufficient in the UK for this condition. CONCLUSION: In the UK the majority of vascular consultants see less than 10 patients annually with lymphoedema. Very few patients undergo confirmation of this diagnosis with non-invasive investigation and very few consultants perform surgery. Management of this condition is perceived by the consultants to be poor, with a lack of resources and particular shortage of lymphoedema physiotherapists. Centralisation of these services may be a way of improving this condition.

BACKGROUND: Lipedema is a rare and painful disease in women. Until recently, it could be treated only by conservative methods (combined physical therapy). OBJECTIVE: To determine the efficacy and safety of surgery (liposuction) concerning appearance and associated complaints. METHODS: Twenty-eight patients, who had undergone conservative therapy over a period of years, were treated by liposuction under tumescent local anesthesia with vibrating microcannulas. Twenty-one could be reevaluated after an average of 12.2 (1-26) months. RESULTS: All showed great improvement, with normalization of body proportions. Additionally, spontaneous pain, sensitivity to pressure, and bruising either disappeared completely or improved markedly. Other than minor swelling for a few days, no complications could be observed following surgery. All patients reported a tremendous increase in their quality of life. Physical therapy had to be continued to a much lower degree. CONCLUSION: Tumescent liposuction has proved to be a safe and effective treatment for lipedema.

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).

Combined decongestive therapy (CDT) in lipedema can only reduce edema, not the fat components; therefore only a portion of the symptoms can be treated. In contrast liposuction is able to reduce the increased volume of fatty tissue; it also decreases the tendency to develop edema. Only by combining conservative and surgical therapy regimens optimal results can be achieved. From the theoretical and practical point of view nowadays in lipedema grade I, II and partially grade III conservative treatment alone can be considered as an insufficient therapy.