Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin Perfusion

Lipedema is a progressive connective tissue disease with enlargement of adipose tissue, fibrosis, fluid collection, and dermal thickening. Herein, we present a case of lipedema associated with skin hypoperfusion and ulceration in which soft tissue debulking with liposuction improved patients' s...

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Main Authors: Feras Alshomer, Seok Joon Lee, Yeongsong Kim, Dae Won Hong, Changsik John Pak, Hyunsuk Peter Suh, Joon Pio Hong
Format: Article
Language:English
Published: Thieme Medical Publishers, Inc.
Series:Archives of Plastic Surgery
Subjects:
Online Access:http://www.thieme-connect.de/DOI/DOI?10.1055/a-2181-8469
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author Feras Alshomer
Seok Joon Lee
Yeongsong Kim
Dae Won Hong
Changsik John Pak
Hyunsuk Peter Suh
Joon Pio Hong
author_facet Feras Alshomer
Seok Joon Lee
Yeongsong Kim
Dae Won Hong
Changsik John Pak
Hyunsuk Peter Suh
Joon Pio Hong
author_sort Feras Alshomer
collection DOAJ
description Lipedema is a progressive connective tissue disease with enlargement of adipose tissue, fibrosis, fluid collection, and dermal thickening. Herein, we present a case of lipedema associated with skin hypoperfusion and ulceration in which soft tissue debulking with liposuction improved patients' symptoms. A 39-year-old female presented with asymmetric progressive initially unilateral lower limb swelling with severe pain with subsequent skin ulceration. Conservative management failed to improve her condition. After excluding other causes and detailed radiologic investigation, lipedema was diagnosed with an associated impaired skin perfusion. Trial of local wound care and compression therapy failed to improve the condition. Subsequent soft tissue debulking with circumferential liposuction and ulcer debridement and immediate compression showed dramatic improvement of the symptoms and skin perfusion. The unique nature of this case sheds light on lipedema as a loose connective tissue disease. Inflammation and microangiopathies explain the associated pain with hypoperfusion and ulceration being quite atypical and in part might be related to the large buildups of matrix proteins and sodium contents leading to fragility in microvessels with frequent petechiae and hematoma and subsequent tissue ischemia. Conservative measures like compression therapy plays a significant role in disease course. Surgical debulking with liposuction was shown to be efficacious in reducing the soft tissue load with improvement in limb pain, edema, circumference, and skin perfusion that was seen in our patient. Lipedema is a frequently misdiagnosed condition with disabling features. Skin involvement in lipedema with potential hypoperfusion was shown and it requires further investigation.
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spelling doaj.art-5db376f1e9c14d5aaa037a24111b9c402024-03-04T23:55:21ZengThieme Medical Publishers, Inc.Archives of Plastic Surgery2234-61632234-617110.1055/a-2181-8469Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin PerfusionFeras Alshomer0https://orcid.org/0000-0001-9282-3845Seok Joon Lee1https://orcid.org/0000-0001-6236-6364Yeongsong Kim2https://orcid.org/0000-0002-6810-4661Dae Won Hong3https://orcid.org/0000-0003-4218-8833Changsik John Pak4https://orcid.org/0000-0002-3477-7120Hyunsuk Peter Suh5https://orcid.org/0000-0003-1706-5516Joon Pio Hong6https://orcid.org/0000-0002-6208-9704Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of KoreaDepartment of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of KoreaDepartment of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of KoreaDepartment of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of KoreaDepartment of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of KoreaDepartment of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of KoreaDepartment of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of KoreaLipedema is a progressive connective tissue disease with enlargement of adipose tissue, fibrosis, fluid collection, and dermal thickening. Herein, we present a case of lipedema associated with skin hypoperfusion and ulceration in which soft tissue debulking with liposuction improved patients' symptoms. A 39-year-old female presented with asymmetric progressive initially unilateral lower limb swelling with severe pain with subsequent skin ulceration. Conservative management failed to improve her condition. After excluding other causes and detailed radiologic investigation, lipedema was diagnosed with an associated impaired skin perfusion. Trial of local wound care and compression therapy failed to improve the condition. Subsequent soft tissue debulking with circumferential liposuction and ulcer debridement and immediate compression showed dramatic improvement of the symptoms and skin perfusion. The unique nature of this case sheds light on lipedema as a loose connective tissue disease. Inflammation and microangiopathies explain the associated pain with hypoperfusion and ulceration being quite atypical and in part might be related to the large buildups of matrix proteins and sodium contents leading to fragility in microvessels with frequent petechiae and hematoma and subsequent tissue ischemia. Conservative measures like compression therapy plays a significant role in disease course. Surgical debulking with liposuction was shown to be efficacious in reducing the soft tissue load with improvement in limb pain, edema, circumference, and skin perfusion that was seen in our patient. Lipedema is a frequently misdiagnosed condition with disabling features. Skin involvement in lipedema with potential hypoperfusion was shown and it requires further investigation.http://www.thieme-connect.de/DOI/DOI?10.1055/a-2181-8469lipedemahypoperfusionliposuctionulcer
spellingShingle Feras Alshomer
Seok Joon Lee
Yeongsong Kim
Dae Won Hong
Changsik John Pak
Hyunsuk Peter Suh
Joon Pio Hong
Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin Perfusion
Archives of Plastic Surgery
lipedema
hypoperfusion
liposuction
ulcer
title Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin Perfusion
title_full Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin Perfusion
title_fullStr Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin Perfusion
title_full_unstemmed Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin Perfusion
title_short Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin Perfusion
title_sort lipedema associated with skin hypoperfusion and ulceration soft tissue debulking improving skin perfusion
topic lipedema
hypoperfusion
liposuction
ulcer
url http://www.thieme-connect.de/DOI/DOI?10.1055/a-2181-8469
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