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 : 64 times PDF Download : 25 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].

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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

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