Suction Assisted Protein Lipectomy (SAPL) Even for the Treatment of Chronic Fibrotic and Scarified Lower Extremity Lymphedema.

Chronic lymphedema results from the accumulation of adipose tissue and fibrotic solids and poses a significant challenge for the treating clinician. Despite its many challenges, chronic lymphedema can be safely and effectively treated using a minimally invasive technique known as suction assisted protein lipectomy (SAPL). We present the use of SAPL in a 65-year-old female with a history of chronic, congenital, non-compressible, solid predominant lymphedema for over 40 years. Her lymphedema was complicated by multiple episodes of severe cellulitis that often required hospitalization and treatment with intravenous antibiotics. The patient also had an excisional procedure designed to debulk the lymphedema swelling performed over 35 years prior by an outside provider. The procedure resulted in substantial scarring and fibrosis between the skin and underlying fascia over a significant area of the leg with only minimal improvement in symptoms. Following SAPL, a stable excess volume reduction of 86% was achieved along with a significant improvement in range of motion of the knee. Furthermore, the patient had no further episodes of recurrent cellulitis. We have found SAPL to be effective even in patients with complex, chronic lymphedema presentations with extensive preexisting scarring from prior surgery..