Tumescent and Dry Liposuction of Lower Extremities: Differences in Lymph Vessel Injury

Abstract

Lipectomy is a standard procedure in plastic surgery. Until now, however, there was no definite information about the influence of different liposuction techniques (tumescent versus dry liposuction) on the integrity of lymph collectors during this procedure. To study the effect of these liposuction techniques on the incidence of lymph vessel injury, postmortem lymphatic preparations were done in nine human cadavers (18 lower extremities). Conventional liposuction with a blunt 4-mm cannula in the dry technique (n = 29 regions) was compared with the tumescent technique (n = 26). Liposuction was performed in parallel to the superficial lymph vessels (longitudinal suction) or transversally in an 80-degree to 90-degree angle to the extremity (vertical suction). Careful surgical preparation of different regions followed. A specific macroscopic lymph vessel injury score was applied to differentiate three degrees of lymph vessel lesions according to the extravasation of patent blue. In all lower extremities, postmortem lymph flow occurred as indicated by patent blue staining of the lymph vessels. Injection of fluid that is obligatory during tumescent suction did not result in grade 2 injury. On the contrary, tumescent suction overall produced significantly fewer lymph vessel lesions when compared with the dry technique (p < 0.05). Longitudinal liposuction produced significantly less injury when compared with vertical suction (p < 0.05). Tumescent suction and dry suction were equally effective in removing adipose aspirates, as verified by circumference measurements. In addition, tumescent liposuction is unlikely to cause major lesions of epifascial lymph vessels during suction procedures vertical to the extremity axis. Therefore, in this respect, this technique is superior to dry suction.

Surgical Management of Lymphedema: Past, Present, and Future

“…Cadaver and imaging studies have demonstrated that liposuction does not disrupt lymphatic vessels (if performed parallel to the limb) and that treatment of lymphedema with liposuction does not decrease the already impaired lymphatic transport capacity of the limb. [59][60][61][62] 164 MEHRARA ET AL.…”

MR Lymphography of Lymphatic Vessels in Lower Extremity with Gynecologic Oncology-Related Lymphedema

“…Secondary LEL in gynecological cancer survivors is often caused by injury to the lymphatic draining systems occurring during surgery [1], [4], [5], [6]. It has also been demonstrated that iatrogenic secondary LEL can occur after stripping of veins, liposuction, arterial revascularization procedures, or even from the biopsy of a single lymph node [7], [8], [9], [10]. To prevent or minimize the occurrence of lymphedema, the lymphatic drainage system in the region of interest for each individual patient must be mapped.…”

Outcome Analysis of Combined Lipoabdominoplasty versus Conventional Abdominoplasty

“…[22][23][24][25] The application of tumescent technique and use of small blunt-tipped cannulas (3.7-mm diameter) over the past decade has further improved liposuction safety. Hoffman et al 26 demonstrated that tumescent technique produces little lymphatic injury among patients as compared with a 50 percent rate of injury in patients who were operated on using dry technique. However, despite the known safety of liposuction, the effectiveness of this procedure is directly Volume 121, Number 5 • Combined Lipoabdominoplasty limited by skin tone.…”