Published : 29 September 2025

Drain and Debulk: A Dual Approach to Advanced Lower Limb Lymphedema Using Simultaneous LVB and Lymph-Sparing Liposuction

  • Aditya Wicaksana
  • Mohamad Rachadian Ramadan
  • Parintosa Atmodiwirjo

Volume 12, Issue 2, Jurnal Plastik Rekonstruksi | Pages : 119-126

DOI: 10.14228/jprjournal.v12i2.51   Reader : 13 times PDF Download : 7 times

Abstract

Background: Advanced-stage lymphedema is characterized by lymphatic dysfunction and fibroadipose overgrowth. Single-modality treatments, such as lymphaticovenous bypass (LVB) or liposuction alone, are often inadequate. This case series evaluates the safety and outcomes of simultaneous LVB and lymph-sparing liposuction in advanced lower-limb disease.
Method: We conducted a case series involving four patients (n=4) with secondary lower limb lymphedema (ISL stage II–III; LDB stage IV–V). All underwent simultaneous LVB and lymph-sparing liposuction. Limb volume was calculated using the truncated cone formula at baseline, 1 week, and 12 months postoperatively. Quality of life was measured using the LYMPH-Q questionnaire. One patient with bilateral lymphedema received LVB on both limbs but underwent liposuction on only one, allowing for direct internal comparison.
Results: In all four patients patients demonstrated immediate postoperative limb volume reductions ranging from 12.13% to 37.68%, with further improvements at 12 months (up to 42.1%). Quality of life scores significantly increased, with improvements of up to 37.29%. In the bilateral case, the limb treated with both LVB and liposuction showed superior outcomes compared to the limb treated with LVB alone. No major complications occurred.
Conclusions: Simultaneous LVB and lymph-sparing liposuction is a safe and effective treatment for advanced lymphedema. This dual-modality approach addresses both fluid accumulation and fibrotic hypertrophy, resulting in better functional and aesthetic outcomes than either technique alone. Larger studies with longer follow-up are needed to confirm these findings and optimize patient selection.

Data Availability

All data generated during this study are included in this published article [and its supplementary information files].

References

  1. 1. Sanka SA, Chryssofos S, Anolik RA, Sacks JM. Advances in surgical management of chronic lymphedema: current strategies and future directions. Medical Oncology. 2025 Jan 13;42(2):44.
  2. 2. Anzai LM, Chang DW. Educational Review: Management of Lymphedema—Approaches, Evidence for Surgical and Nonsurgical Interventions. Annals of Surgical Oncology. 2025 May 20:1-9.
  3. 3. Karlsson T, Hoffner M, Ohlin K, Svensson B, Brorson H. Complete reduction of leg lymphedema after liposuction: a 5-year prospective study in 67 patients without recurrence. Plastic and Reconstructive Surgery–Global Open. 2023 Dec 1;11(12):e5429.
  4. 4. Gabriele G, Nigri A, Chisci G, Massarelli O, Cascino F, Komorowska-Timek E, Kazuki K, Hara H, Mihara M, Gennaro P. Combination of supramicrosurgical lymphatico-venular anastomosis (sLVA) and lymph-sparing liposuction in treating cancer-related lymphedema: rationale for a regional one-stage approach. Journal of Clinical Medicine. 2024 May 13;13(10):2872.
  5. 5. Kaur MN, Cornacchi SD, Tsangaris E, Poulsen L, Beelen LM, Bordeleau L, Zhong T, Jorgensen MG, Sorensen JA, Mehrara B, Dayan J. Iterative qualitative approach to establishing content validation of a patient-reported outcome measure for arm lymphedema: the LYMPH-Q Upper Extremity Module. Journal of Patient-Reported Outcomes. 2024 Jun 26;8(1):63.
  6. 6. Han EJ, Lee J, Hong JP. Predicting the outcome of lymphovenous anastomosis for extremity lymphedema: a prospective cohort study. Plast Reconstr Surg. 2025;xx:xx-xx.
  7. 7. Perets M, Izhakian S, Gutman H, et al. The evidence for the microsurgical management of lymphedema: a systematic review. Lymphat Res Biol. 2024;22(3):xx-xx.
  8. 8. Karlsson T, Brorson H. Complete reduction of leg lymphedema after liposuction and controlled compression therapy: 5-year outcomes. Plast Reconstr Surg Glob Open. 2023;11:e5489.
  9. 9. Yoshida S, Yoshimatsu H, Yamamoto T, et al. Comparison of the effectiveness of liposuction for lower vs upper extremity lymphedema following physiologic surgery. Plast Reconstr Surg Glob Open. 2023;11:e4842.
  10. 10. Lo SL, Leung J, Lo KK, et al. Debulking lymphatic liposuction: are the therapeutic goals achieved? J Surg Oncol. 2025;131(6):1001-1013.
  11. 11. Gabriele G, Nigri A, Chisci G, et al. Combination of supramicrosurgical lymphatico-venular anastomosis and lymph-sparing liposuction in treating cancer-related lymphedema: rationale for a regional one-stage approach. J Clin Med. 2024;13(10):2872.
  12. 12. Zurbuchen EA, Chen W, Chen HC. Modern approaches to lymphatic surgery: a narrative review. Transl Breast Cancer Res. 2025;6:xx-xx.
  13. 13. Anzai LM, Patel KM, Labow BI, et al. Management of lymphedema—approaches, evidence for effectiveness, and future directions. Ann Med Surg (Lond). 2025;xx:xx-xx.
  14. 14. Yamamoto T, Mihara M, Chang DW, et al. Staging approaches to lymphatic surgery: techniques and treatment algorithms. J Surg Oncol. 2024;130(6):1100-1112.
  15. 15. Kaur MN, Klassen AF, Pusic AL, et al. The LYMPH-Q upper extremity module: content validity and implications for clinical practice. J Patient-Rep Outcomes. 2024;8:xx-xx.
  16. 16. Grünherz L, Ueberreiter K, Forte AJ, et al. Cultural adaptation and multicenter validation of the German LYMPH-Q. J Patient-Rep Outcomes. 2022;6:88.
  17. 17. Thomas M, Nixon J, Stephens R, et al. A new validated lymphoedema-specific patient-reported outcome measure (LYMPROM). PLoS One. 2025;20(7):e03153.
PDF

Keywords

  • Lymphedema
  • Lymphaticovenous Bypass
  • Lymphaticovenous Anastomosis
  • Liposuction
  • Microsurgery

Author Information

Aditya Wicaksana

Division of Plastic, Reconstructive and Aesthetic Surgery, Dr. Sardjito Hospital, Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada, Indonesia.

Email: aditya_wicaksana@mail.ugm.ac.id

ORCID : https://orcid.org/0000-0001-8890-4474

Mohamad Rachadian Ramadan

Reconstructive Microsurgery and Oncoplasty Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.

Email: rachadian@ui.ac.id

ORCID : https://orcid.org/0000-0003-2231-9314

Parintosa Atmodiwirjo

Reconstructive Microsurgery and Oncoplasty Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.

Email: parintosa.atmodiwirjo@ui.ac.id

ORCID : https://orcid.org/0000-0002-8912-0468

Article History

Submitted : 26 September 2025
Revised : 26 September 2025
Published : 29 September 2025

How to Cite This

Wicaksana, A., Ramadan, M. R., & Atmodiwirjo, P. (2025). Drain and Debulk: A Dual Approach to Advanced Lower Limb Lymphedema Using Simultaneous LVB and Lymph-Sparing Liposuction . Jurnal Plastik Rekonstruksi, 12(2), 119–126. https://doi.org/10.14228/jprjournal.v12i2.51

Crossmark and Dimension

Verify authenticity via CrossMark

Share This Article

Copyright & License

Authors retain the copyright of the article and grant Jurnal Plastik Rekonstruksi the right of first publication with the work simultaneously licensed under a Creative Commons Attribution License. Articles opting for open access will be immediately available and permanently free for everyone to read, download and share from the time of publication.

This work is licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International

Open Access Statement

Jurnal Plastik Rekonstruksi is an open access journal. This journal provides immediate open access to every article on the principle that making research freely accessible to the public; It supports a greater global exchange of knowledge; and an invaluable way to boost the visibility and impact of research.

This also means that Jurnal Plastik Rekonstruksi it's free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than that inseparable from gaining access to the Internet itself.

Journal Info

Profile Image
Editor-in-Chief: dr. Narottama Tunjung, Sp.B.P.R.E., F.L.
Frequency: 2 issues per year (March & September)
National Accreditation: Sinta 3
Email: info@jprjournal.com

Video Article

Multistages Aesthetic Refinement Post Anterolateral Thigh Free Flap in Head and Neck Reconstruction

Atmodiwirjo P, Ramadan MR, Triatmoko SE, Arina MN. Multistages Aesthetic Refinement Post Anterolateral Thigh Free Flap in Head and Neck Reconstruction. J Plast Rekons 2020;7(1):38-42. DOI: https://doi.org/10.14228/jpr.v7i1.298

How to Harvest The Radial Forearm Free Flap

Atmodiwirjo P, Ramadan MR, Triatmoko SE, Ralena NA. How to Harvest Radial Forearm Free Flap. J Plast Rekons 2020;7(1):7-9. DOI: https://doi.org/10.14228/jpr.v7i1.296  

ACCREDITATION

Since October 2020, Jurnal Plastik Rekonstruksi has received Accreditation from the Ministry of Technology Research / National Research and Innovation Agency (SINTA 3)

https://sinta.ristekbrin.go.id/journals/detail?id=2054

Indexed by:

   

.    

custom_header

ISSN : 2089-6492
Online ISSN : 2089-9734
Publisher: The Lingkar Studi Bedah Plastik Foundation and is the official journal of Plastic Reconstructive and Aesthetic Surgery Residency Program, Faculty of Medicine, Universitas Indonesia.

Current Issue