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CC BY 4.0 · Arch Plast Surg 2024; 51(03): 311-316
DOI: 10.1055/a-2181-8469
Extremity/Lymphedema
Case Report

Lipedema associated with Skin Hypoperfusion and Ulceration: Soft Tissue Debulking Improving Skin Perfusion

Feras Alshomer 
1   Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
,
Seok Joon Lee 
1   Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
,
Yeongsong Kim 
1   Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
,
Dae Won Hong 
1   Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
,
Changsik John Pak 
1   Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
,
Hyunsuk Peter Suh 
1   Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
,
Joon Pio Hong 
1   Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, Seoul Asan Medical Center, Seoul, Republic of Korea
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Abstract

Lipedema is a progressive connective tissue disease with enlargement of adipose tissue, fibrosis, fluid collection, and dermal thickening. Herein, we present a case of lipedema associated with skin hypoperfusion and ulceration in which soft tissue debulking with liposuction improved patients' symptoms. A 39-year-old female presented with asymmetric progressive initially unilateral lower limb swelling with severe pain with subsequent skin ulceration. Conservative management failed to improve her condition. After excluding other causes and detailed radiologic investigation, lipedema was diagnosed with an associated impaired skin perfusion. Trial of local wound care and compression therapy failed to improve the condition. Subsequent soft tissue debulking with circumferential liposuction and ulcer debridement and immediate compression showed dramatic improvement of the symptoms and skin perfusion. The unique nature of this case sheds light on lipedema as a loose connective tissue disease. Inflammation and microangiopathies explain the associated pain with hypoperfusion and ulceration being quite atypical and in part might be related to the large buildups of matrix proteins and sodium contents leading to fragility in microvessels with frequent petechiae and hematoma and subsequent tissue ischemia. Conservative measures like compression therapy plays a significant role in disease course. Surgical debulking with liposuction was shown to be efficacious in reducing the soft tissue load with improvement in limb pain, edema, circumference, and skin perfusion that was seen in our patient. Lipedema is a frequently misdiagnosed condition with disabling features. Skin involvement in lipedema with potential hypoperfusion was shown and it requires further investigation.

Keywords

lipedema - hypoperfusion - liposuction - ulcer

Authors' Contributions

Conceptualization: J.P.H., H.P.S., and C.J.P. Writing—original draft: F.A., S.J.L., Y.K., and D.W.H. Data collection: S.J.L., Y.K., and D.W.H. Writing—final draft: F.A. Final editing and reviewing: J.P.H., H.P.S., and C.J.P.


Ethical Approval

This study was conducted in accordance with the local ethical committee policy in Asan medical center, Seoul. South Korea.


Patient Consent

Written informed consent was obtained from the patient.




Publication History

Received: 15 November 2022

Accepted: 19 September 2023

Accepted Manuscript online:
26 September 2023

Article published online:
04 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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