Debulking Surgery for Elephantiasis Nostras

By February 6, 2016Lymphedema, Treatment

Debulking Surgery for Elephantiasis Nostras With Large Ectatic Podoplanin-Negative Lymphatic Vessels in Patients With Lipo-Lymphedema

Wollina U, Heinig B, Schonlebe J, Nowak A; 2014

Synopsis: This study presents two cases of advanced lipo-lymphedema complicated by elephantiasis nostras, in which patients are treated with tumescent microcannular laser-assisted liposuction as well as a debulking surgery.

Abstract: OBJECTIVE: Elephantiasis nostras is a rare complication in advanced lipo-lymphedema. While lipedema can be treated by liposuction and lymphedema by decongestive lym- phatic therapy, elephantiasis nostras may need debulking surgery.

METHODS: We present 2 cases of advanced lipo-lymphedema complicated by elephantiasis nostras. After tumescent microcannular laser-assisted liposuction both patients underwent a debulking surgery with a modification of Auchincloss-Kims technique. Histologic examination of the tissue specimen was performed.

RESULTS: The surgical treatment was well tolerated and primary healing was uneventful. After primary wound healing and ambulation of the patients, a delayed ulceration with lymphorrhea developed. It was treated by sur- gical necrectomy and vacuum-assisted closure leading to complete healing. Mobility of the leg was much improved. Histologic examination revealed massive ectatic lym- phatic vessels nonreactive for podoplanin.

CONCLUSIONS: Debulking surgery can be an adjuvant technique for elephantiasis nostras in advanced lipo-lymphedema. Although delayed postoperative wound healing problems were observed, necrectomy and vacuum- assisted closure achieved a complete healing. Histologic data suggest that the ectatic lymphatic vessels in these patients resemble finding in podoplanin knockout mice. The findings would explain the limitations of decongestive lymphatic therapy and tumescent liposuction in such patients and their predisposition to relapsing erysipelas.

APA Citation: Wollina, U., Heinig, B., Schnlebe, J., & Nowak, A. (2014). Debulking surgery for elephantiasis nostras with large ectatic podoplanin-negative lymphatic vessels in patients with lipo-lymphedema. Eplasty, 14.

AMA Citation: Wollina U, Heinig B, Schnlebe J, Nowak A. Debulking surgery for elephantiasis nostras with large ectatic podoplanin-negative lymphatic vessels in patients with lipo-lymphedema. Eplasty. 2014;14.