Liposuction and Controlled Compression Therapy Reduce the Erysipelas Incidence in Primary and Secondary Lymphedema

Abstract

Background: Skin infections are a recurring problem for people with lymphedema, and lymphedema has been proven to be the single most important risk factor for developing erysipelas in the leg. This study aimed to determine whether liposuction for late-stage lymphedema reduces the rate of erysipelas in lower extremity lymphedema.

Methods: One-hundred twenty-four patients with a median age of 49 years who had liposuction and controlled compression therapy for lower extremity lymphedema were included. Excess volumes were calculated before and after surgery. Median preoperative and postoperative patient years at risk were 11 and 5 years, respectively.

Results: With a total of 1680 preoperative person years at risk and 335 bouts of erysipelas experienced in 64 patients, the preoperative incidence rate was 0.20 bouts per person per year, and the period prevalence was 52%. Postoperatively, the patients were followed over a total of 763 person years at risk, and 28 patients experienced a total of 53 bouts of erysipelas, resulting in a postoperative incidence rate of 0.07 bouts per person per year, and a period prevalence of 23%. This represents a 65% decrease in the erysipelas incidence rate (P < 0.001). The preoperative median excess volume of 3158 ml was reduced with a median of 100% (P < 0.0001).

Conclusions: Liposuction and controlled compression therapy significantly reduce the risk for erysipelas in lower extremity lymphedema and completely reduces the excess volume. This finding is similar to our previous research including patients with upper extremity lymphedema.

Fig. 1.

Pre- and postoperative excess volume reduction (median, IQR). Following surgery, a significant reduction was seen after 1 year, which was maintained at the most recent follow-up.

Fig. 2.

Liposuction completely reduces the excess volume. A, A 50-year-old woman with a preoperative excess volume of 4415 ml in the left leg following treatment of uterine cancer 12 years before liposuction. At surgery 4470 ml adipose tissue was removed. B, At 8 years after liposuction, the excess volume was –180 ml, a slight overcorrection.

Fig. 3.

Liposuction completely reduces the excess volume. A, A 31-year-old woman with primary lymphedema for 6 years and a preoperative excess volume of 4565 ml in the right leg. At surgery 4420 ml was removed. B, At 2 years after liposuction the excess volume is –45 ml, a slight overcorrection.

Fig. 4.

Flowchart illustrating the number of patients included in the study who experienced at least one bout of erysipelas before and after liposuction. n = number of patients.

Fig. 5.

Correlation between the absolute postoperative reduction in erysipelas incidence rate and the latest volume ratio (volume affected leg/volume nonaffected leg). No significant correlation could be found, Spearman correlation coefficient ρ = –0.14 (P = 0.14).