Schaverien Mark V, Munnoch D Alex, Brorson Håkan
Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Plastic and Reconstructive Surgery, Ninewells Hospital and Medical School, Dundee, United Kingdom.
Semin Plast Surg. 2018 Feb;32(1):42-47. doi: 10.1055/s-0038-1635116. Epub 2018 Apr 9.
In the Western world, lymphedema most commonly occurs following treatment of cancer. Limb reductions have been reported utilizing various conservative therapies including manual lymph and pressure therapy, as well as by microsurgical reconstruction involving lymphovenous shunts and transplantation of lymph vessels or nodes. Failure of these conservative and surgical treatments to provide complete reduction in patients with long-standing pronounced lymphedema is due to the persistence of excess newly formed subcutaneous adipose tissue in response to slow or absent lymph flow, which is not removed in patients with chronic non-pitting lymphedema. Traditional surgical regimes utilizing bridging procedures, total excision with skin grafting, or reduction plasty seldom achieved acceptable cosmetic and functional results. Liposuction removes the hypertrophied adipose tissue and is a prerequisite to achieve complete reduction, and this reduction is maintained long-term through constant (24 h) use of compression garments postoperatively. This article describes the techniques and evidence basis for the use of liposuction for treatment of lymphedema.
在西方世界，淋巴水肿最常见于癌症治疗之后。据报道，肢体缩小可通过多种保守疗法实现，包括手动淋巴引流和压力疗法，以及涉及淋巴静脉分流和淋巴管或淋巴结移植的显微外科重建手术。对于长期存在明显淋巴水肿的患者，这些保守治疗和手术治疗未能实现完全消肿，原因是由于淋巴流动缓慢或缺失，新形成的皮下脂肪组织持续过多，而慢性非凹陷性淋巴水肿患者的这种脂肪组织无法消除。采用搭桥手术、带皮肤移植的全切除手术或缩小成形术的传统手术方案很少能取得可接受的美容和功能效果。抽脂术可去除肥厚的脂肪组织，是实现完全消肿的先决条件，术后持续（24小时）使用加压衣可长期维持这种消肿效果。本文介绍了抽脂术治疗淋巴水肿的技术及证据基础。
