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

Liposuction is a standard procedure in plastic surgery. Especially, lipectomy with suction of the lower extremities has been of greater interest in recent years. Until now, however, there was no definite information about the integrity of epifascial lymph collectors during this procedure. To study the effect of liposuction devices on lymph vessel injury, postmortem lymphatic 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 and, therefore, in parallel to the superfascial lymph vessels or transversally in an 80- to 90-degree angle to the extremity. Careful surgical preparation of the regions followed. A specific macroscopic lymph vessel injury score 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 vessels. Lymph vessel injury was more severe in areas where liposuction was performed transversally, vertical to the extremity's axis, than in those after a longitudinal procedure. The difference was statistically significant (p < 0.01). The volumes of adipoaspirate and of the compared regions were comparable between both groups, verified by circumference measurements. Longitudinal liposuction of the lower extremities is unlikely to cause major lesions of epifascial lymph vessels and, therefore, should be preferred in comparison to liposuction vertical to the extremity.