A Single Institution Multi-disciplinary Approach to Power-assisted Liposuction for the Management of Lymphedema
A Single Institution Multi-disciplinary Approach to Power-assisted Liposuction for the Management of Lymphedema
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DOI：
10.1097/sla.0000000000004588
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发表时间：
2022-11-01
影响因子：
9
通讯作者：
Singhal, Dhruv
中科院分区：
文献类型：
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作者：
Granoff, Melisa D.;Johnson, Anna Rose;Singhal, Dhruv
目的：在美国实施一项综合性、多学科减积计划并评估其结果。背景数据总结：近年来，在美国，对慢性水肿（LE）手术治疗的兴趣和使用率有所增加，但对抽脂或减脂作为有效治疗选择的关注仍然很少。在其他一些国家，减积是LE手术治疗的常见程序，由保险覆盖，并已证明具有良好的可重复结果。在这项研究中，我们描述了我们的经验，实施减瘤技术从瑞典在美国。方法：对慢性LE患者进行系统的多学科检查。对于使用动力辅助吸脂的减瘤，手术方案仿照Hakan Brorson开发的方案。对在我们机构接受减积的连续患者进行了回顾性分析。结果如下：在2017年12月至2020年1月期间，39名患者接受了41次动力辅助吸脂减积手术，包括23例上肢和18例下肢。患者平均年龄为58岁，85%的患者患有继发于癌症的LE，其中大多数（64%）为乳腺癌。术后1年时，患者上肢和下肢分别经历了116%和115%的过度减容。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的发生率降低，对保守治疗方式的依赖性降低。结论：负压吸脂术是治疗慢性肢体LE的有效方法。该手术解决了患者的目标，提高了生活质量，并减少了肢体体积，感染率和对门诊治疗的依赖。一个全面的，多学科的减瘤计划可以在美国的医疗保健系统中成功实施。
Objective: To implement and evaluate outcomes from a comprehensive, multi-disciplinary debulking program in the United States. Summary of Background Data: 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. Methods: 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 Hakan Brorson. A retrospective review of consecutive patients who underwent debulking at our institution was conducted. Results: 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. Conclusions: 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.