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Single-stage VASER-assisted Liposuction And Lymphatico-venous Anastomoses For The Treatment Of Extremity Lymphedema: A Case Series And Systematic Review Of The Literature
Samyd S. Bustos1, Oscar J. Manrique, M.D., F.A.C.S.1, Mouchammed Agko, M.D.2, Tony CT Huang, M.D., M.Sc.1, Eduardo Figueroa Benites, M.D.3, Maria I. Vargas, M.D.3, Antonio J. Forte, M.D., Ph.D., M.S.4, Pedro Ciudad, M.D., Ph.D.3.
1Mayo Clinic, Rochester, MN, USA, 2Augusta University, Augusta, GA, USA, 3Arzobispo Loayza National Hospital, Lima, Peru, 4Mayo Clinic, Jacksonville, FL, USA.

PURPOSE: A paradigm shift towards the use of combined physiological and excisional surgical approaches for the treatment of lymphedema is permeating the surgical practice worldwide. We describe a single-stage surgical approach combining VASER-assisted liposuction (VAL) and lymphatico-venous anastomoses (LVA) for the treatment of extremity-lymphedema.
METHODS: Between March 2018 and March 2019, a retrospective review of patients with extremity-lymphedema stage IIb-III International Society of Lymphology who underwent the combined technique was done. Demographics, operative characteristics, changes in clinical parameters, and complications were assessed. Additionally, a systematic review of studies that reported combined physiological procedures with liposuction for the treatment of lymphedema was conducted.
RESULTS: A total of 24 patients (12 upper extremity-lymphedema, UEL, and 12 lower extremity-lymphedema, LEL) were included and analyzed. The mean age was 54.5 years (38 - 72). The mean circumference reduction rate was 90% and 85% for UEL and LEL, respectively. Infection rate decreased to zero postoperatively in all patients. Ten studies were included in the review: six pooling 220 cases included two-stage procedures, and four pooling 66 cases described one-stage surgeries. All patients who underwent a combined approach reported clinical improvement.
CONCLUSION: This combined surgical approach is safe and allows adequate limb size reduction with faster recovery in selected patients with lymphedema with strong fibrotic component.


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