Excisional lipectomy versus liposuction in HIV-associated lipodystrophy
Background Human immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Thieme Medical Publishers, Inc.
2021-11-01
|
| Series: | Archives of Plastic Surgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2020.02285 |
| _version_ | 1798004708949884928 |
|---|---|
| author | Natalie Barton Ryan Moore Karthik Prasad Gregory Evans |
| author_facet | Natalie Barton Ryan Moore Karthik Prasad Gregory Evans |
| author_sort | Natalie Barton |
| collection | DOAJ |
| description | Background Human immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies have described the successful removal of focal areas of lipohypertrophy with successful outcomes. This manuscript reviews the outcomes of excisional lipectomy versus liposuction for HIV-associated cervicodorsal lipodystrophy.
Methods We performed a 15-year retrospective review of HIV-positive patients with lipodystrophy. Patients were identified by query of secure operative logs. Data collected included demographics, medications, comorbidities, duration of HIV, surgical intervention type, pertinent laboratory values, and the amount of tissue removed.
Results Nine male patients with HIV-associated lipodystrophy underwent a total of 17 procedures. Of the patients who underwent liposuction initially (n=5), 60% (n=3) experienced a recurrence. There were a total of three cases of primary liposuction followed by excisional lipectomy. One hundred percent of these cases were noted to have a recurrence postoperatively, and there was one case of seroma formation. Of the subjects who underwent excisional lipectomy (n=4), there were no documented recurrences; however, one patient’s postoperative course was complicated by seroma formation.
Conclusions HIV-associated lipodystrophy is a disfiguring complication of HAART therapy with significant morbidity. Given the limitations of liposuction alone as the primary intervention, excisional lipectomy is recommended as the primary treatment. Liposuction may be used for better contouring and for subsequent procedures. While there is a slightly higher risk for complications, adjunctive techniques such as quilting sutures and placement of drains may be used in conjunction with excisional lipectomy. |
| first_indexed | 2024-04-11T12:27:41Z |
| format | Article |
| id | doaj.art-2bbb1ec7a5cd4629a63fa4a29d10d4b3 |
| institution | Directory Open Access Journal |
| issn | 2234-6163 2234-6171 |
| language | English |
| last_indexed | 2024-04-11T12:27:41Z |
| publishDate | 2021-11-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Archives of Plastic Surgery |
| spelling | doaj.art-2bbb1ec7a5cd4629a63fa4a29d10d4b32022-12-22T04:23:52ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-61712021-11-01480668569010.5999/aps.2020.022853922Excisional lipectomy versus liposuction in HIV-associated lipodystrophyNatalie Barton0Ryan Moore1Karthik Prasad2Gregory Evans3Department of Plastic Surgery, University of California Irvine, Orange, CA, USADepartment of Plastic Surgery, University of California Irvine, Orange, CA, USASchool of Medicine, University of California Irvine, Orange, CA, USADepartment of Plastic Surgery, University of California Irvine, Orange, CA, USABackground Human immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies have described the successful removal of focal areas of lipohypertrophy with successful outcomes. This manuscript reviews the outcomes of excisional lipectomy versus liposuction for HIV-associated cervicodorsal lipodystrophy. Methods We performed a 15-year retrospective review of HIV-positive patients with lipodystrophy. Patients were identified by query of secure operative logs. Data collected included demographics, medications, comorbidities, duration of HIV, surgical intervention type, pertinent laboratory values, and the amount of tissue removed. Results Nine male patients with HIV-associated lipodystrophy underwent a total of 17 procedures. Of the patients who underwent liposuction initially (n=5), 60% (n=3) experienced a recurrence. There were a total of three cases of primary liposuction followed by excisional lipectomy. One hundred percent of these cases were noted to have a recurrence postoperatively, and there was one case of seroma formation. Of the subjects who underwent excisional lipectomy (n=4), there were no documented recurrences; however, one patient’s postoperative course was complicated by seroma formation. Conclusions HIV-associated lipodystrophy is a disfiguring complication of HAART therapy with significant morbidity. Given the limitations of liposuction alone as the primary intervention, excisional lipectomy is recommended as the primary treatment. Liposuction may be used for better contouring and for subsequent procedures. While there is a slightly higher risk for complications, adjunctive techniques such as quilting sutures and placement of drains may be used in conjunction with excisional lipectomy.http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2020.02285lipodystrophyliposuctionlipectomyhiv |
| spellingShingle | Natalie Barton Ryan Moore Karthik Prasad Gregory Evans Excisional lipectomy versus liposuction in HIV-associated lipodystrophy Archives of Plastic Surgery lipodystrophy liposuction lipectomy hiv |
| title | Excisional lipectomy versus liposuction in HIV-associated lipodystrophy |
| title_full | Excisional lipectomy versus liposuction in HIV-associated lipodystrophy |
| title_fullStr | Excisional lipectomy versus liposuction in HIV-associated lipodystrophy |
| title_full_unstemmed | Excisional lipectomy versus liposuction in HIV-associated lipodystrophy |
| title_short | Excisional lipectomy versus liposuction in HIV-associated lipodystrophy |
| title_sort | excisional lipectomy versus liposuction in hiv associated lipodystrophy |
| topic | lipodystrophy liposuction lipectomy hiv |
| url | http://www.thieme-connect.de/DOI/DOI?10.5999/aps.2020.02285 |
| work_keys_str_mv | AT nataliebarton excisionallipectomyversusliposuctioninhivassociatedlipodystrophy AT ryanmoore excisionallipectomyversusliposuctioninhivassociatedlipodystrophy AT karthikprasad excisionallipectomyversusliposuctioninhivassociatedlipodystrophy AT gregoryevans excisionallipectomyversusliposuctioninhivassociatedlipodystrophy |