Journal
JOURNAL OF CLINICAL MEDICINE
Volume 11, Issue 3, Pages -Publisher
MDPI
DOI: 10.3390/jcm11030570
Keywords
lymphedema; lymphedema of the lower limbs; LYMQoL questionnaire; quality of life; vascularized lymph node transfer; lymph node flap; bilateral lymphedema; primary lymphedema; modified Charles procedure; liposuction
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Bilateral lower extremity lymphedema is a rare and debilitating condition. This study found that a combination of lymph node transfer and reductive methods can effectively treat the condition and significantly reduce the number of cellulitis episodes. Timely treatment and BMI control are crucial in preventing cellulitis.
Background: Bilateral lower extremity lymphedema is a rare and invalidating condition that poses a great challenge to the scientific community, and deeply affects the quality of life (QoL) of affected patients. A combined protocol consisting of lymph node transfer and a reductive method have never been reported for the treatment of this condition, except for small case series with brief follow-up periods. Methods: This retrospective study analyzed data of 29 patients, mean age 51 +/- 17.1 years, who had been diagnosed with bilateral lower extremity lymphedema. Gastroepiploic vascularized lymph node transfer was performed in all the patients, and an excisional procedure was associated according to the clinical stage. Clinical history, circumferential limb measurements, complications, episodes of cellulitis, and responses to the Lymphedema Quality of Life Questionnaire were analyzed. Results: The mean follow-up was 38.4 +/- 11.8 months. A significant reduction in the episodes of cellulitis per year was observed (p < 0.001). In our series, BMI and duration of symptoms were significantly related to the development of cellulitis during the postoperative period, p = 0.006 and p = 0.020, respectively. The LYMQoL questionnaire showed a significant quality of life improvement from 3.4 +/- 0.9 to 6.2 +/- 0.8 (p < 0.05). Conclusions: An integrated approach is essential for the treatment of bilateral lower extremity lymphedema: reductive and reconstructive methods are complementary to achieve a successful outcome. Timely treatment and BMI reduction are relevant in order to decrease the number of episodes of cellulitis. An attentive follow-up is necessary to identify recurrence and treat affected patients in time.
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