Liposuction technique and lymphatic lesions in lower legs: Anatomic study to reduce risks

Liposuction is a standard procedure in plastic surgery. Especially, lipecto my with suction of the lower extremities has been of greater inter est in r ecent years. Until now, however, there was no definite information about th e integrity of epifascial lymph collectors during this procedure . To study the effect of liposuction devices on lymph vessel injury, postmortem lymph atic preparations were done in five human cadavers (10 lower extremities). Conventional liposuction with a blunt 4-mm cannula and a dry technique was used. Adiposuction was performed either in parallel to the extremity axis a nd, therefore, in parallel to the superfascial lymph vessels or transversal ly in an 80- to 90-degree angle to the extremity. Careful surgical preparat ion of the regions followed. A specific macroscopic lymph vessel injury sco re was applied to differentiate 3 degrees of lymph vessel lesions according to the extravasation of patent blue. In all lower extremities, postmortem lymph flow occurred as indicated by patent blue staining of the lymph vesse ls. Lymph vessel injury was more severe in areas where liposuction was perf ormed transversally, vertical to the extremity's axis, than in those after a longitudinal procedure. The difference was statistically sig nificant (p < 0.01). The volumes of adipoaspirate and of the compared regions were comp arable between both groups, verified by circumference measurements. Longitu dinal liposuction of the lower extremities is unlikely to cause major lesio ns of epifascial lymph vessels and, therefore, should be preferred in compa rison to liposuction vertical to the extremity.