The diagnostic and surgical challenges of massive localized lymphedema - 13/03/15
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Abstract |
Background |
Massive localized lymphedema (MLL) is a rare entity first described in 1998 in patients with morbid obesity; the incidence is rising with the increased prevalence of morbid obesity. This report defines the clinical presentation and surgical challenges in 6 patients with MLL.
Methods |
The MLL in 6 patients with morbid obesity (weight range 270 to 585 lbs) involved the thigh in 3 patients, the calf in 1 patient, and the abdomen in 2 patients. The time from onset to presentation averaged 3 years (range 1 to 8 years). Two thigh lesions precluded ambulation because both legs could not be on the ground simultaneously; the 2 abdominal lesions were too heavy to permit ambulation.
Results |
The surgical excision required the use of pulleys to elevate the MLL tissues, which, on excision, weighed between 24 and 78 lbs. A long oval horizontal incision and a long transverse incision were used for the 2 abdominal lesions. Long horizontal oval limb incisions with multiple perpendicular cross incisions had to be used to excise MLL in the 4 limb lesions. In 2 cases, the vessel-sealing device was employed successfully for dissecting subcutaneous edematous tissue. Loose wound closure permitted postoperative lymph leakage, which continued for 3 to 8 weeks. The histology demonstrated fibrotic lymphatic tissue with vascular and lymphatic proliferation and edema; all patients did well.
Conclusions |
MLL is rare and is best treated by surgical excision facilitated by pulleys and imaginative incisions to obtain primary closure. Long-term follow-up is necessary to assess for subsequent liposarcoma or angiosarcoma.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Massive localized lymphedema is a rare and benign condition seen in morbidly obese patients. |
• | Massive localized lymphedema typically has large size and weight. It is localized and composed of lymphoproliferative tissue that appears similar to a sarcoma grossly. |
• | Conservative treatment with compression techniques is mostly unsuccessful. |
• | Indications for surgical excision are massive size prevents ambulation, recurrent skin infections, and inability to exclude sarcoma. |
• | Pulley-based system to lift the heavy tissue and vessel-sealing device is very helpful in surgical resection |
Keywords : Massive localized lymphedema, Presentation, Surgical challenges
Plan
There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs. |
|
The authors declare no conflicts of interest. |
Vol 209 - N° 3
P. 584-587 - mars 2015 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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