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OBJECTIVE: Many investigations and treatments exist for lower limb lymphoedema. We undertook a survey on the management of this condition by vascular surgeons and the resources available for its treatment in the UK. DESIGN: A questionnaire was designed to assess the management of lymphoedema. MATERIALS AND METHOD: A postal questionnaire was sent to all members of the The Vascular Society of Great Britain and Ireland. RESULTS: 251/440 (57%) consultant surgeons returned a completed questionnaire comprising 45.3% teaching hospital and 54.7% district general hospital (DGH) consultants. 77.9% of the consultants saw less than 10 patients annually with lymphoedema. The commonest causes of lymphoedema were primary lymphoedema (99.3%) and malignancy (37.1%). Lipoedema, a cause of limb swelling was only seen or recognised by 46.2% of the consultants. The commonest investigations performed were a duplex scan, lymphoscintigram, full blood count and urea and electrolytes. The common methods of confirming lymphoedema were either by lymphoscintigram (54.5%) or from a diagnosis of exclusion (33.7%). Lymphoedema physiotherapy was available only to 53.8% of the consultants. Surgery was performed by 10.5% of consultants. 73.4% of the consultants believed that lymphoedema is managed inadequately and 72.9% believed that resources are insufficient in the UK for this condition. CONCLUSION: In the UK the majority of vascular consultants see less than 10 patients annually with lymphoedema. Very few patients undergo confirmation of this diagnosis with non-invasive investigation and very few consultants perform surgery. Management of this condition is perceived by the consultants to be poor, with a lack of resources and particular shortage of lymphoedema physiotherapists. Centralisation of these services may be a way of improving this condition.

BACKGROUND: Lipedema is a rare and painful disease in women. Until recently, it could be treated only by conservative methods (combined physical therapy). OBJECTIVE: To determine the efficacy and safety of surgery (liposuction) concerning appearance and associated complaints. METHODS: Twenty-eight patients, who had undergone conservative therapy over a period of years, were treated by liposuction under tumescent local anesthesia with vibrating microcannulas. Twenty-one could be reevaluated after an average of 12.2 (1-26) months. RESULTS: All showed great improvement, with normalization of body proportions. Additionally, spontaneous pain, sensitivity to pressure, and bruising either disappeared completely or improved markedly. Other than minor swelling for a few days, no complications could be observed following surgery. All patients reported a tremendous increase in their quality of life. Physical therapy had to be continued to a much lower degree. CONCLUSION: Tumescent liposuction has proved to be a safe and effective treatment for lipedema.

Compiled by an internationally renowned pioneer in the field of lymphology with contributions from leading experts, this textbook explores all aspects of lymphological science, including the causes, diagnoses, prognoses, and treatments for primary and secondary Lymphedema. Comprehensive discussions address all the essential topics relevant to lymphology, such as anatomy, physiology, and pathophysiology. Therapists will benefit from practical information on clinical findings as well as instructions for performing manual lymph drainage.Provides a detailed presentation of the anatomy and physiology of the lymphatic system.Explores the causes, diagnoses, therapies and prognoses of all lymphological conditions from a physician's perspective.Includes a well-founded and practical discussion on the techniques, effects and implementation of Complete Decongestive Therapy (CDT).

Combined decongestive therapy (CDT) in lipedema can only reduce edema, not the fat components; therefore only a portion of the symptoms can be treated. In contrast liposuction is able to reduce the increased volume of fatty tissue; it also decreases the tendency to develop edema. Only by combining conservative and surgical therapy regimens optimal results can be achieved. From the theoretical and practical point of view nowadays in lipedema grade I, II and partially grade III conservative treatment alone can be considered as an insufficient therapy.

Lipoedema is a form of lipodistrophy, which consists of abnormal accumulation of fat in subcutaneous tissue of the lower limbs. It does not cause any disease and it has not been reported association with malignity. We describe a 63-year-old woman occurring of Kaposi sarcoma on the lipoedema base.

Purpose: Assessment of the relation between age and lymph transport in lipedema patients using lymphoscintigraphic function test. Material and methods: 99mTc human serum nanocolloid (37 MBq) was injected subcutaneously into the dorsum of foot (n = 290 feet) in female patients suffering of lipedema, lipolipedema or patients with normal lymph transport. Patients were enrolled in standardized exercise tasks. For the radioisotope uptake calculation regional lymph nodes depth was determined by SPECT (single photon computed tomography). Results: The lymph node uptake of young patients (until 35 years) reaches higher values than the normal collective and decreases significantly with age until it drop's below the normal collective. Conclusions: The lymphoscintigraphic function test of the legs showed an increased transport function of the epifascial lymphatic system by younger and a decreased transport function by elder patients with lipedema compared to the normal population, the high transport values suggest a high lymphatic volume with compensatory capacity increase of the lymphatic system in young patients. According to these results of the lymphatic transport function the age of the patients has to be regarded.

The primary lymphedema is a pathological interstitial accumulation of lymphatic fluid. Lower limbs are mainly affected by primary lymphedema. It is caused by a hereditary lack or complete absence of lymphatic vessel systeme. Final complications of chronic limb lymphedema include »elephantiasis«, lymphatic ulceration and malignant degeneration. Secondary lymphedema, obesity, phlebedema and lipedema are most important differential diagnoses.Treatment of primary lymphedema includes early manual lymph drainages, decrease in weight, exercise, prevention or therapy of skin infections. Up to the present primary lymhedema cannot be cured in causality.

Lipoedema: Improved Quality of Life by Combination of Therapies Lipoedema is a chronic progressive disease with increased fat volumes mainly of the legs, causing body disproportion together with orthostatic oedema, pain and bruising. Early diagnosis can be achieved by clinical symptoms. Complex physical therapy with manual lymphatic drainage, compression and physiotherapy reduces oedema and complaints. Surgical therapy with liposuction reduces circumscribed fat volumes, improves body proportions and diminishes oedema and bruising. Following surgery physical therapy can be diminished in intensity and number. Nowadays the combination of physiotherapy and liposuction is considered the optimal treatment regime which can tremendously improve the patient's quality of life.

Modern aspects of pathophysiology, epidemiology, symptoms, diagnosis and therapy in lipedema are presented. Within recent years the development of new techniques in local anaesthesia and surgery has revolutionized therapy. By using surgical and conservative methods (tumescent liposuction and combined decongestive therapy) a normalization of body proportions and a reduction of subjective and objective symptoms with a distinct improvement in the quality of life can be achieved.