title: Massive localized lymphedema (MLL) in bariatric candidates.
abstract: BACKGROUND
  Mild lymphedema of lower limbs and eventually abdomen is not exceedingly rare in morbid obesity. However, few large symptomatic masses have been reported. In a consecutive series of patients, all requiring resection of the lesion before bariatric treatment, clinical features and surgical findings are described, aiming to clarify the nature of this intricate problem.
  
  
  METHODS
  Subjects (n=4, 50% females, age 34.0+/-13.7 years (19-53), BMI 56.4+/-10.5 kg/m(2) (44.1-73.1) displayed lesions on the anteromedial aspect of the thigh (n=3) and hypogastrium (n=1). All reported episodes of intertrigo of local skin-folds in the preceding years, managed by local care and antibiotics. The mass was described as a serious nuisance, impairing walking, dressing and personal hygiene.
  
  
  RESULTS
  The mass was surgically removed without requirement for blood transfusion except in the case of one huge mass. Complications were relatively minor and consisted of partial skin dehiscence and lymph leakage for 2-3 weeks. Histologically, a complex pattern was observed including skin hypertrophy, edema, fibrosis, foci of microabscesses and dilated blood vessels, along with the pathognomonic lymphangiectasia. On follow-up to 6 months, improvement or restoration of the ability to walk occurred, with no additional skin infection and no recurrence.
  
  
  CONCLUSIONS
  1) Surgical treatment was effective. 2) Functional rehabilitation was achieved. 3) No recurrence was observed within the follow-up period.
authors.affiliation: Plastic Surgery, Hospital das Clinicas, São Paulo, SP, Brazil. miguelmodolin@uol.com.br
authors.forename: Miguel L A
authors.initials: ML
authors.lastname: Modolin
authors.forename: Wilson
authors.initials: W
authors.lastname: Cintra
authors.forename: André O
authors.initials: AO
authors.lastname: Paggiaro
authors.forename: Joel
authors.initials: J
authors.lastname: Faintuch
authors.forename: Rolf
authors.initials: R
authors.lastname: Gemperli
authors.forename: Marcus C
authors.initials: MC
authors.lastname: Ferreira
mesh_terms: D000005:Abdomen; D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D012720:Severity of Illness Index; D013848:Thigh; D016896:Treatment Outcome