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Massive Localized Lymphedema: A Case-Control Study.

Reid A Maclellan1, David Zurakowski2, Frederick D Grant3

  • 1Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, Boston, MA.

Journal of the American College of Surgeons
|December 5, 2016
PubMed
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Massive localized lymphedema (MLL) is caused by obesity-induced lymphedema (OIL). A body mass index (BMI) over 56 kg/m² significantly increases MLL risk in obese patients.

Area of Science:

  • Medical research
  • Obesity studies
  • Lymphedema research

Background:

  • Massive localized lymphedema (MLL) is characterized by skin and subcutaneous overgrowth in obese individuals.
  • The relationship between MLL and obesity-induced lymphedema (OIL) requires further investigation.
  • Understanding MLL's prevalence and risk factors is crucial for effective management.

Purpose of the Study:

  • To determine if Massive Localized Lymphedema (MLL) is a result of Obesity-Induced Lymphedema (OIL).
  • To identify the prevalence and risk factors associated with MLL in obese patients.
  • To establish a predictive threshold for BMI in relation to MLL development.

Main Methods:

  • Retrospective review of 82 obese patients (BMI ≥30 kg/m²) evaluated between 2009 and 2016.

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  • Lower-extremity lymphatic function assessed using lymphoscintigraphy.
  • Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis used to identify risk factors and BMI cutoff for MLL.

    • Main Results:

    • All 17 patients with MLL had OIL; none had primary or secondary lymphedema (median BMI 66 kg/m²).
    • MLL commonly affected the thigh (n=16), genitalia (n=3), and suprapubic area (n=2).
    • A BMI >56 kg/m² was associated with a 213-fold increased odds of developing MLL (p < 0.0001).

    Conclusions:

    • Massive localized lymphedema (MLL) is a direct consequence of obesity-induced lymphedema (OIL).
    • Approximately 60% of obese patients with lower-extremity dysfunction develop MLL.
    • Referral to bariatric weight-loss programs is recommended for obese individuals before BMI reaches a critical threshold for OIL and MLL.