title: Madelung's Disease: Revision of 59 Surgical Cases.
abstract: BACKGROUND
  Madelung's disease (MD) is a rare disease, more common in Mediterranean countries and associated with alcohol abuse. However, MD etiology remains not completely understood.
  
  
  OBJECTIVE
  The aim of this study was to investigate clinical features, treatment options and outcomes in patients with MD treated in our plastic surgery department.
  
  
  METHODS
  We retrospectively reviewed 59 cases of MD operated on between 2004 and 2013. Demographic information, location of the deposits, associated pathology and habits, number and type of surgeries performed, surgical complications and disease evolution were analyzed.
  
  
  RESULTS
  Ninety percent of the patients were males. Active or past history of alcohol abuse was reported by 86%. The main affected areas were anterior and posterior neck. A total of 230 surgical procedures were performed. Open surgery was used on 192 occasions (83.5%), liposuction alone on 30 procedures (13%) and lipectomy combined with liposuction on 8 interventions (3.5%). Surgical complications were found in 41 procedures (17.8%). Twenty-three patients (39%) were identified as having disease recurrence of the operated site in a mean time of 3.8 years. Alcohol consumption was not clearly associated with disease recurrence.
  
  
  CONCLUSIONS
  Demographic characteristics of the studied cohort stand for published data. It is our opinion that lipectomy/dermolipectomy provides better aesthetic and functional results. Lipectomy procedures allow a thorough excision, correct identification of noble structures and careful hemostasis. Liposuction techniques, even ultrasound-assisted ones, had limited efficacy for the treatment of large masses. A long follow-up period is recommended considering the high propensity and mean time to recurrence.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: Hospital da Prelada, Rua de Sarmento de Beires, 153, 4250-449, Porto, Portugal. cristinacalvopinto@gmail.com.
authors.forename: Cristina Isabel Calvo
authors.identifier: http://orcid.org/0000-0002-9640-8726
authors.initials: CI
authors.lastname: Pinto
authors.affiliation: Hospital da Prelada, Rua de Sarmento de Beires, 153, 4250-449, Porto, Portugal.
authors.forename: Pedro João Marques Cardoso
authors.initials: PJ
authors.lastname: Carvalho
authors.affiliation: Hospital da Prelada, Rua de Sarmento de Beires, 153, 4250-449, Porto, Portugal.
authors.forename: Manuel Maia Oliveira
authors.initials: MM
authors.lastname: Correia
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism; D005260:Female; D006801:Humans; D015187:Lipectomy / Q000379:methods*; D008069:Lipomatosis, Multiple Symmetrical / Q000145:classification / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies
keywords: Launois-Bensaude syndrome; Madelung’s disease; Multiple symmetric lipomatosis; Surgical treatment