In an early stage lymphedema, lymphovenous bypass surgery will provide good chance for improvement. However, hypertrophied adipose tissues do not respond to such procedures. In contrast to microsurgical procedures, liposuction enables the complete removal of the deposited adipose tissue. Indications for liposuction include followings. (1) Volume excess could not managed by conservative management. (2) Patients have discomfort from heavy arm or leg. (3) The affected extremities are hypertrophied in advanced stage. (4) The extremity shows no pitting edema. Although liposuction can effectively reduce hypertrophied limbs, some relapse of symptoms will appear when the patients neglect wearing compression garments and performing decongestive therapy. In cases with high fluid contents, lymph drain surgery such as lymph node transfer can precede and liposuction can be done concomitantly or later. The combined approaches have advantage of immediate improvement and low relapse rate. Post-operative compressive treatment is almost always necessary, and multidisciplinary approach should be continued.
Kim et al. (Fri,) studied this question.