Granoff Melisa D, Johnson Anna Rose, Shillue Kathy, Fleishman Aaron, Tsai Leo, Carroll Brett, Donohoe Kevin, Lee Bernard T, Singhal Dhruv
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Ann Surg. 2022 Nov 1;276(5):e613-e621. doi: 10.1097/SLA.0000000000004588. Epub 2020 Nov 4.
To implement and evaluate outcomes from a comprehensive, multi-disciplinary debulking program in the United States.
Interest in and access to surgical treatment for chronic lymphedema (LE) in the United States have increased in recent years, yet there remains little attention on liposuction, or debulking, as an effective treatment option. In some other countries, debulking is a common procedure for the surgical treatment of LE, is covered by insurance, and has demonstrated excellent, reproducible outcomes. In this study we describe our experience implementing a debulking technique from Sweden in the United States.
Patients who presented with chronic LE followed a systematic multi-disciplinary work-up. For debulking with power assisted liposuction, the surgical protocol was modeled after that developed by Håkan Brorson. A retrospective review of consecutive patients who underwent debulking at our institution was conducted.
Between December 2017 and January 2020, 39 patients underwent 41 debulking procedures with power assisted liposuction, including 23 upper and 18 lower extremities. Mean patient age was 58 years and 85% of patients had LE secondary to cancer, the majority of which (64%) was breast cancer. Patients experienced excess volume reductions of 116% and 115% in the upper and lower extremities, respectively, at 1 year postoperatively. Overall quality of life (LYMQOL) improved by a mean of 33%. Finally, patients reported a decreased incidence of cellulitis and decreased reliance on conservative therapy modalities postoperatively.
Debulking with power assisted liposuction is an effective treatment for patients with chronic extremity LE. The operation addresses patient goals and improves quality of life, and additionally reduces extremity volumes, infection rates and reliance on outpatient therapy. A comprehensive, multi-disciplinary debulking program can be successfully implemented in the United States healthcare system.
在美国实施并评估一项全面的多学科减容计划的效果。
近年来，美国对慢性淋巴水肿（LE）手术治疗的兴趣和可及性有所增加，但作为一种有效治疗选择的抽脂术或减容术仍未得到足够关注。在其他一些国家，减容术是LE手术治疗的常见方法，可获保险覆盖，且已显示出优异、可重复的效果。在本研究中，我们描述了在美国实施瑞典减容技术的经验。
患有慢性LE的患者接受了系统的多学科检查。对于动力辅助抽脂减容术，手术方案以哈坎·布罗尔松制定的方案为蓝本。对在我们机构接受减容术的连续患者进行了回顾性研究。
2017年12月至2020年1月期间，39例患者接受了41次动力辅助抽脂减容手术，其中上肢23例，下肢18例。患者平均年龄为58岁，85%的患者LE继发于癌症，其中大多数（64%）为乳腺癌。术后1年，患者上肢和下肢的多余体积分别减少了116%和115%。总体生活质量（LYMQOL）平均提高了33%。最后，患者报告术后蜂窝织炎发病率降低，对保守治疗方式的依赖减少。
动力辅助抽脂减容术是慢性肢体LE患者的有效治疗方法。该手术实现了患者的目标，提高了生活质量，此外还减少了肢体体积、感染率以及对门诊治疗的依赖。一项全面的多学科减容计划能够在美国医疗保健系统中成功实施。
