Chronic
lymphedema results from the accumulation of adipose tissue and fibrotic solids and poses a significant challenge for the treating clinician. Despite its many challenges, chronic
lymphedema can be safely and effectively treated using a minimally invasive technique known as suction assisted
protein lipectomy (SAPL). We present the use of SAPL in a 65-year-old female with a history of chronic, congenital, non-compressible, solid predominant
lymphedema for over 40 years. Her
lymphedema was complicated by multiple episodes of severe
cellulitis that often required hospitalization and treatment with intravenous
antibiotics. The patient also had an excisional procedure designed to debulk the
lymphedema swelling performed over 35 years prior by an outside provider. The procedure resulted in substantial
scarring and
fibrosis between the skin and underlying fascia over a significant area of the leg with only minimal improvement in symptoms. Following SAPL, a stable excess volume reduction of 86% was achieved along with a significant improvement in range of motion of the knee. Furthermore, the patient had no further episodes of recurrent
cellulitis. We have found SAPL to be effective even in patients with complex, chronic
lymphedema presentations with extensive preexisting
scarring from prior surgery..