Treatment of elderly patients with advanced lipedema: a combination of laser-assisted liposuction, medial thigh lift, and lower partial abdominoplasty
Identifieur interne : 002644 ( Pmc/Curation ); précédent : 002643; suivant : 002645Treatment of elderly patients with advanced lipedema: a combination of laser-assisted liposuction, medial thigh lift, and lower partial abdominoplasty
Auteurs : Uwe Wollina [Allemagne] ; Birgit Heinig [Allemagne] ; Andreas Nowak [Allemagne]Source :
- Clinical, Cosmetic and Investigational Dermatology [ 1178-7015 ] ; 2014.
Abstract
Lipedema is a rare female disorder with a characteristic distribution of adipose tissue hypertrophy on the extremities, with pain and bruising. In advanced stages, reduction of adipose tissue is the only available effective treatment. In elderly patients with advanced lipedema, correction of increased skin laxity has to be considered for an optimal outcome.
We report on a tailored combined approach to improve advanced lipedema in elderly females with multiple comorbidities. Microcannular laser-assisted liposuction of the upper legs and knees is performed under tumescent anesthesia. Medial thigh lift and partial lower abdominoplasty with minimal undermining are used to correct skin laxity and prevent intertrigo. Postsurgical care with nonelastic flat knitted compression garments and manual lymph drainage are used.
We report on three women aged 55–77 years with advanced lipedema of the legs and multiple comorbidities. Using this step-by-step approach, a short operation time and early mobilization were possible. Minor adverse effects were temporary methemoglobinemia after tumescent anesthesia and postsurgical pain. No severe adverse effects were seen. Patient satisfaction was high.
A tailored approach may be useful in advanced lipedema and is applicable even in elderly patients with multiple comorbidities.
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DOI: 10.2147/CCID.S56655
PubMed: 24489474
PubMed Central: 3904776
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Treatment of elderly patients with advanced lipedema: a combination of laser-assisted liposuction, medial thigh lift, and lower partial abdominoplasty</title><author><name sortKey="Wollina, Uwe" sort="Wollina, Uwe" uniqKey="Wollina U" first="Uwe" last="Wollina">Uwe Wollina</name><affiliation wicri:level="1"><nlm:aff id="af1-ccid-7-035">Department of Dermatology and Allergology, Dresden, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Dermatology and Allergology, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Heinig, Birgit" sort="Heinig, Birgit" uniqKey="Heinig B" first="Birgit" last="Heinig">Birgit Heinig</name><affiliation wicri:level="1"><nlm:aff id="af2-ccid-7-035">Centre of Physical Therapy and Rehabilitative Medicine, Dresden, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Centre of Physical Therapy and Rehabilitative Medicine, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Nowak, Andreas" sort="Nowak, Andreas" uniqKey="Nowak A" first="Andreas" last="Nowak">Andreas Nowak</name><affiliation wicri:level="1"><nlm:aff id="af3-ccid-7-035">Department of Anaesthesiology and Intensive Medical Care, Emergency Medicine and Pain Management, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Anaesthesiology and Intensive Medical Care, Emergency Medicine and Pain Management, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24489474</idno><idno type="pmc">3904776</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904776</idno><idno type="RBID">PMC:3904776</idno><idno type="doi">10.2147/CCID.S56655</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002645</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002645</idno><idno type="wicri:Area/Pmc/Curation">002644</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002644</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Treatment of elderly patients with advanced lipedema: a combination of laser-assisted liposuction, medial thigh lift, and lower partial abdominoplasty</title><author><name sortKey="Wollina, Uwe" sort="Wollina, Uwe" uniqKey="Wollina U" first="Uwe" last="Wollina">Uwe Wollina</name><affiliation wicri:level="1"><nlm:aff id="af1-ccid-7-035">Department of Dermatology and Allergology, Dresden, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Dermatology and Allergology, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Heinig, Birgit" sort="Heinig, Birgit" uniqKey="Heinig B" first="Birgit" last="Heinig">Birgit Heinig</name><affiliation wicri:level="1"><nlm:aff id="af2-ccid-7-035">Centre of Physical Therapy and Rehabilitative Medicine, Dresden, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Centre of Physical Therapy and Rehabilitative Medicine, Dresden</wicri:regionArea></affiliation></author><author><name sortKey="Nowak, Andreas" sort="Nowak, Andreas" uniqKey="Nowak A" first="Andreas" last="Nowak">Andreas Nowak</name><affiliation wicri:level="1"><nlm:aff id="af3-ccid-7-035">Department of Anaesthesiology and Intensive Medical Care, Emergency Medicine and Pain Management, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Anaesthesiology and Intensive Medical Care, Emergency Medicine and Pain Management, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden</wicri:regionArea></affiliation></author></analytic><series><title level="j">Clinical, Cosmetic and Investigational Dermatology</title><idno type="eISSN">1178-7015</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Lipedema is a rare female disorder with a characteristic distribution of adipose tissue hypertrophy on the extremities, with pain and bruising. In advanced stages, reduction of adipose tissue is the only available effective treatment. In elderly patients with advanced lipedema, correction of increased skin laxity has to be considered for an optimal outcome.</p></sec><sec><title>Methods</title><p>We report on a tailored combined approach to improve advanced lipedema in elderly females with multiple comorbidities. Microcannular laser-assisted liposuction of the upper legs and knees is performed under tumescent anesthesia. Medial thigh lift and partial lower abdominoplasty with minimal undermining are used to correct skin laxity and prevent intertrigo. Postsurgical care with nonelastic flat knitted compression garments and manual lymph drainage are used.</p></sec><sec><title>Results</title><p>We report on three women aged 55–77 years with advanced lipedema of the legs and multiple comorbidities. Using this step-by-step approach, a short operation time and early mobilization were possible. Minor adverse effects were temporary methemoglobinemia after tumescent anesthesia and postsurgical pain. No severe adverse effects were seen. Patient satisfaction was high.</p></sec><sec><title>Conclusion</title><p>A tailored approach may be useful in advanced lipedema and is applicable even in elderly patients with multiple comorbidities.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Child, Ah" uniqKey="Child A">AH Child</name></author><author><name sortKey="Gordon, Kd" uniqKey="Gordon K">KD Gordon</name></author><author><name sortKey="Sharpe, P" uniqKey="Sharpe P">P Sharpe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Suga, H" uniqKey="Suga H">H Suga</name></author><author><name sortKey="Araki, J" uniqKey="Araki J">J Araki</name></author><author><name sortKey="Aoi, N" uniqKey="Aoi N">N Aoi</name></author><author><name sortKey="Kato, H" uniqKey="Kato H">H Kato</name></author><author><name sortKey="Higashino, T" uniqKey="Higashino T">T Higashino</name></author><author><name sortKey="Yoshimura, K" uniqKey="Yoshimura K">K Yoshimura</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Meier Vollrath, I" uniqKey="Meier Vollrath I">I Meier-Vollrath</name></author><author><name sortKey="Schmeller, W" uniqKey="Schmeller W">W Schmeller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schmeller, W" uniqKey="Schmeller W">W Schmeller</name></author><author><name sortKey="Hueppe, M" uniqKey="Hueppe M">M Hueppe</name></author><author><name sortKey="Meier Vollrath, I" uniqKey="Meier Vollrath I">I Meier-Vollrath</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wollina, U" uniqKey="Wollina U">U Wollina</name></author><author><name sortKey="Goldman, A" uniqKey="Goldman A">A Goldman</name></author><author><name sortKey="Heinig, B" uniqKey="Heinig B">B Heinig</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rapprich, S" uniqKey="Rapprich S">S Rapprich</name></author><author><name sortKey="Dingler, A" uniqKey="Dingler A">A Dingler</name></author><author><name sortKey="Podda, M" uniqKey="Podda M">M Podda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wollina, U" uniqKey="Wollina U">U Wollina</name></author><author><name sortKey="Heinig, B" uniqKey="Heinig B">B Heinig</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Peled, Aw" uniqKey="Peled A">AW Peled</name></author><author><name sortKey="Slavin, Sa" uniqKey="Slavin S">SA Slavin</name></author><author><name sortKey="Brorson, H" uniqKey="Brorson H">H Brorson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dibernardo, Be" uniqKey="Dibernardo B">BE DiBernardo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goldman, A" uniqKey="Goldman A">A Goldman</name></author><author><name sortKey="Wollina, U" uniqKey="Wollina U">U Wollina</name></author><author><name sortKey="De Mundstock, Ec" uniqKey="De Mundstock E">EC de Mundstock</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Labardi, L" uniqKey="Labardi L">L Labardi</name></author><author><name sortKey="Gentile, P" uniqKey="Gentile P">P Gentile</name></author><author><name sortKey="Gigliotti, S" uniqKey="Gigliotti S">S Gigliotti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lockwood, T" uniqKey="Lockwood T">T Lockwood</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Del Pino, Roxo" uniqKey="Del Pino R">Roxo Del Pino</name></author><author><name sortKey="Wenck, Roxo" uniqKey="Wenck R">Roxo Wenck</name></author><author><name sortKey="Ac, Varela V" uniqKey="Ac V">Varela V AC</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Del, Pino Roxo C" uniqKey="Del P">Pino Roxo C Del</name></author><author><name sortKey="Weck, Roxo Ac" uniqKey="Weck R">Roxo AC Weck</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="El Khatib, Ha" uniqKey="El Khatib H">HA El-Khatib</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Langer, V" uniqKey="Langer V">V Langer</name></author><author><name sortKey="Singh, A" uniqKey="Singh A">A Singh</name></author><author><name sortKey="Aly, As" uniqKey="Aly A">AS Aly</name></author><author><name sortKey="Cram, Ae" uniqKey="Cram A">AE Cram</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chand, M" uniqKey="Chand M">M Chand</name></author><author><name sortKey="Armstrong, T" uniqKey="Armstrong T">T Armstrong</name></author><author><name sortKey="Britton, G" uniqKey="Britton G">G Britton</name></author><author><name sortKey="Nash, G" uniqKey="Nash G">G Nash</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tsuchiya, H" uniqKey="Tsuchiya H">H Tsuchiya</name></author><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin Cosmet Investig Dermatol</journal-id><journal-id journal-id-type="iso-abbrev">Clin Cosmet Investig Dermatol</journal-id><journal-id journal-id-type="publisher-id">Clinical, Cosmetic and Investigational Dermatology</journal-id><journal-title-group><journal-title>Clinical, Cosmetic and Investigational Dermatology</journal-title></journal-title-group><issn pub-type="epub">1178-7015</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24489474</article-id><article-id pub-id-type="pmc">3904776</article-id><article-id pub-id-type="doi">10.2147/CCID.S56655</article-id><article-id pub-id-type="publisher-id">ccid-7-035</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Series</subject></subj-group></article-categories><title-group><article-title>Treatment of elderly patients with advanced lipedema: a combination of laser-assisted liposuction, medial thigh lift, and lower partial abdominoplasty</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Wollina</surname><given-names>Uwe</given-names></name><xref ref-type="aff" rid="af1-ccid-7-035">1</xref><xref ref-type="corresp" rid="c1-ccid-7-035"></xref></contrib><contrib contrib-type="author"><name><surname>Heinig</surname><given-names>Birgit</given-names></name><xref ref-type="aff" rid="af2-ccid-7-035">2</xref></contrib><contrib contrib-type="author"><name><surname>Nowak</surname><given-names>Andreas</given-names></name><xref ref-type="aff" rid="af3-ccid-7-035">3</xref></contrib></contrib-group><aff id="af1-ccid-7-035"><label>1</label>Department of Dermatology and Allergology, Dresden, Germany</aff><aff id="af2-ccid-7-035"><label>2</label>Centre of Physical Therapy and Rehabilitative Medicine, Dresden, Germany</aff><aff id="af3-ccid-7-035"><label>3</label>Department of Anaesthesiology and Intensive Medical Care, Emergency Medicine and Pain Management, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany</aff><author-notes><corresp id="c1-ccid-7-035">Correspondence: Uwe Wollina, Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067 Dresden, Germany, Email <email>wollina-uw@khdf.de</email></corresp></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>23</day><month>1</month><year>2014</year></pub-date><volume>7</volume><fpage>35</fpage><lpage>42</lpage><permissions><copyright-statement>© 2014 Wollina et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License</copyright-statement><copyright-year>2014</copyright-year><license><license-p>The full terms of the License are available at <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p></license></permissions><abstract><sec><title>Background</title><p>Lipedema is a rare female disorder with a characteristic distribution of adipose tissue hypertrophy on the extremities, with pain and bruising. In advanced stages, reduction of adipose tissue is the only available effective treatment. In elderly patients with advanced lipedema, correction of increased skin laxity has to be considered for an optimal outcome.</p></sec><sec><title>Methods</title><p>We report on a tailored combined approach to improve advanced lipedema in elderly females with multiple comorbidities. Microcannular laser-assisted liposuction of the upper legs and knees is performed under tumescent anesthesia. Medial thigh lift and partial lower abdominoplasty with minimal undermining are used to correct skin laxity and prevent intertrigo. Postsurgical care with nonelastic flat knitted compression garments and manual lymph drainage are used.</p></sec><sec><title>Results</title><p>We report on three women aged 55–77 years with advanced lipedema of the legs and multiple comorbidities. Using this step-by-step approach, a short operation time and early mobilization were possible. Minor adverse effects were temporary methemoglobinemia after tumescent anesthesia and postsurgical pain. No severe adverse effects were seen. Patient satisfaction was high.</p></sec><sec><title>Conclusion</title><p>A tailored approach may be useful in advanced lipedema and is applicable even in elderly patients with multiple comorbidities.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>lipedema</kwd><kwd>tumescent anesthesia</kwd><kwd>liposuction</kwd><kwd>subdermal diode laser</kwd><kwd>medial thigh lift</kwd><kwd>lower abdominoplasty</kwd></kwd-group></article-meta></front><floats-group><fig id="f1-ccid-7-035" position="float"><label>Figure 1</label><caption><p>A 72-year-old woman with lipedema grade 3 according to the Meier-Vollrath and Schmeller classification.<xref rid="b3-ccid-7-035" ref-type="bibr">3</xref> She had had an unsuccessful lipectomy of the upper legs a couple of years earlier (see suprapatellar scars). (<bold>A</bold>) and (<bold>B</bold>) Initial presentation with side and front view. (<bold>B</bold>) Operation site of medial thigh lift. (<bold>C</bold>) Operation site of medial thigh lift. (<bold>D</bold>) After suturing. (<bold>E</bold>) About 4 weeks later. (<bold>F</bold>) and (<bold>G</bold>) Outcome of the thigh lift with improved tissue laxity about 8 weeks later.</p></caption><graphic xlink:href="ccid-7-035Fig1"></graphic><graphic xlink:href="ccid-7-035Fig2"></graphic></fig><fig id="f2-ccid-7-035" position="float"><label>Figure 2</label><caption><p>A 77-year-old woman with lipedema grade 3 according to the Meier-Vollrath and Schmeller classification.<xref rid="b3-ccid-7-035" ref-type="bibr">3</xref> (<bold>A</bold>) Asymmetric proximal lipedema of the legs, laxity of the abdominal skin, and ptosis and bulging of the pubic area. (<bold>B</bold>) After laser-assisted liposuction and correction of thigh laxity by medial thigh lift 6 days after surgery. (<bold>C</bold>) Medial thigh lift. (<bold>D</bold>) Lower abdominoplasty with skin and adipose tissue resection. Scarpa’s fascia is exposed. (<bold>E</bold>) Cross view of resection specimen demonstrating the massive enlarged fat lobules of the deeper layer of adipose tissue. (<bold>F</bold>) Puboplasty. (<bold>G</bold>) Result 3 days after surgery. Some minor bruising is still evident but contours has been markedly improved.</p></caption><graphic xlink:href="ccid-7-035Fig3"></graphic><graphic xlink:href="ccid-7-035Fig4"></graphic></fig><fig id="f3-ccid-7-035" position="float"><label>Figure 3</label><caption><p>A 55-year-old woman with lipedema grade 3 according to the Meier-Vollrath and Schmeller classification.<xref rid="b3-ccid-7-035" ref-type="bibr">3</xref> (<bold>A</bold>) Before lower abdominal lipoplasty. (<bold>B</bold>) Four days after surgery, with minor bruising. (<bold>C</bold>) Two weeks after lower abdominoplasty, showing markedly improved body contour. (<bold>D</bold>) Patient with tailored compression garment.</p></caption><graphic xlink:href="ccid-7-035Fig5"></graphic></fig><table-wrap id="t1-ccid-7-035" position="float"><label>Table 1</label><caption><p>Patient characteristics</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">Patient</th><th align="left" valign="top" rowspan="1" colspan="1">Age (years)</th><th align="left" valign="top" rowspan="1" colspan="1">BMI</th><th align="left" valign="top" rowspan="1" colspan="1">Comorbidities</th></tr></thead><tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">1</td><td align="left" valign="top" rowspan="1" colspan="1">55</td><td align="left" valign="top" rowspan="1" colspan="1">33</td><td align="left" valign="top" rowspan="1" colspan="1">Coxarthrosis and gonarthrosis, diabetes mellitus, arterial hypertension, multiple drug and contact allergies</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">2</td><td align="left" valign="top" rowspan="1" colspan="1">72</td><td align="left" valign="top" rowspan="1" colspan="1">35</td><td align="left" valign="top" rowspan="1" colspan="1">Arterial hypertension, atopic dermatitis, osteoarthritis, venous insufficiency</td></tr><tr><td align="left" valign="top" rowspan="1" colspan="1">3</td><td align="left" valign="top" rowspan="1" colspan="1">77</td><td align="left" valign="top" rowspan="1" colspan="1">42</td><td align="left" valign="top" rowspan="1" colspan="1">Dilated cardiomyopathy, diabetes mellitus with renal insufficiency, pulmonary hypertension, coxarthrosis and gonarthrosis</td></tr></tbody></table><table-wrap-foot><fn id="tfn1-ccid-7-035"><p><bold>Abbreviation:</bold> BMI, body mass index.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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