Liposuction of arm and leg lymphedema - Tissue composition alterations and treatment outcomes

Lymphedema is a lifelong incurable condition caused by trauma to the lymphatic tracts or from developmental defects. The condition causes severe negative impact on patients’ quality of life and treatment alternative have historically not offered the desired results of total volume reduction with a cosmetically acceptable appearance. Based on the fact that lymphedema over time leads to fat deposition in the affected area, liposuction for lymphedema were introduced more than 20 years ago and have since become a recognized and widely used treatment alternative. Results from the procedure indicate that on average, the increase in volume can be reduced to normal and the results can be maintained over time with the use of compression garments.

This dissertation is an international collaboration between Lund University and Macquarie University in Sydney, Australia, under a Cotutelle Joint PhD. The aim of the project is to further investigate the long-term outcome of liposuction for lymphedema, as well as to dig deeper into the pathophysiological changes lymphedema causes by analyzing arm and leg lymphedema with different diagnostic imaging techniques.

Have you ever experienced your feet swell during a long flight, or an area around a wound become infected and swell to the point where you can press with your finger and it will create a dent in the skin? Now imaging you notice your right leg start to swell in a similar manner, starting from the foot and reaching all the way to the groin. After some time, you decide to go see a physician after the leg have increased with liters and liters of excess volume, who tells you that you suffer from a condition called lymphedema. If this were, say, 100 years ago, the physician might had continued saying that the only way of reducing the size of your leg to normal is by cutting off all the skin and fat on your leg and to cover the whole surface with skin transplant. Wait, what?

Although not so dramatic in modern times, finding the perfect treatment for lymphedema is still difficult. We know a lot about how lymphedema develops. Most often it starts with surgery for cancer (breast, gynecological and skin cancer etc.), when lymph nodes are removed, but it can also be caused by developmental errors or infections. We also know what the swelling consists of. Lymph is a fluid that derives from the blood circulation and contains proteins (and other nutrients) outside the blood vessels. So, lymphedemas consist initially of just that, fluid. We also know that the body after some time reacts by producing more fat when there is too much of this fluid. Now, it becomes more difficult to restore the volume back to normal since we can´t compress the fat away from the leg, which is possible when it is just fluid. So, the fat needs to be removed as well. But how?

Liposuction for lymphedema might sound like a simple solution but it offers the possibility of reducing the size back to normal without causing significant scarring. Since hundredth of millions of people are affected by lymphedema worldwide, the importance of an effective, but still simple, method of treating advanced lymphedema becomes evident. This project will evaluate the results of liposuction over time as well as to dig deeper into the appearance of lymphedema at different stages of the condition.