title: An Integrative Therapeutic Concept for Surgical Treatment of Severe Cases of Lymphedema of the Lower Extremity.
abstract: Lymphedema results from insufficient lymphatic drainage and typically affects the extremities. Recent studies revealed obesity as another cause of extremity lymphedema. Conservative treatment of patients with elephantiastic lymphedema of the lower extremity is limited and often inadequate. Resecting surgery plays an important role in these cases. Here, we investigated the effects of an integrated therapy concept on outcome and complication rates.
  
  
  
  We retrospectively analyzed the clinical outcome of 26 patients with elephantiastic lymphedema of the lower limb who underwent a complex decongestive physical therapy (CDP) perioperatively and reduction surgery in our clinic between 1998 and 2011. We subsequently compared these patients (group A) with a control group of 30 patients (group B) who received medial thigh lift due to post-bariatric or aesthetic issues between 2011 and 2013. The incidence of complications, reoperations, blood transfusion, and duration of hospital stay was analyzed. All patients in group A received CDP perioperatively in a specialized lymphological clinic.
  
  
  
  Both groups are comparable in terms of age and sex. Patients significantly differ in terms of BMI (p < 0.001). Thirty-six reductive procedures were performed in group A and 30 in group B. We did not see any significant difference in the incidence of complications (p = 1.000) and the rate of postoperative blood transfusions (p = 0.116).
  
  
  
  We were able to show that an integrative concept including surgery is a good additional option for the treatment of severe cases of lymphedema in appropriate candidates. Furthermore, an adequate perioperative conservative setting helps to minimize possible complications.
authors.affiliation: Department of Hand, Plastic and Reconstructive Surgery, Burn Centre, BG Trauma Center Ludwigshafen, Plastic and Hand Surgery, University of Heidelberg, Ludwig-Guttman-Str. 13, D-67071, Ludwigshafen, Germany. jurij.kiefer@bgu-ludwigshafen.de.
authors.forename: Jurij
authors.initials: J
authors.lastname: Kiefer
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, Freiburg, Germany.
authors.forename: Georgios
authors.initials: G
authors.lastname: Koulaxouzidis
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, Freiburg, Germany.
authors.forename: G Björn
authors.initials: GB
authors.lastname: Stark
authors.affiliation: Földi Clinic for Lymphology, Hinterzarten, Germany.
authors.forename: Etelka
authors.initials: E
authors.lastname: Foeldi
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, Freiburg, Germany.
authors.forename: Nestor
authors.initials: N
authors.lastname: Torio-Padron
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, Freiburg, Germany.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Penna
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008209:Lymphedema / Q000534:rehabilitation / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Decongestive physical therapy; Elephantiasis; Lymphedema; Medial thigh lift; Wedge skin resection