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Published on: February 10, 2021
Massive Localized Lymphedema, Wound Care Without Major Surgical Excision: A Case Report
Danique J I Heuvelings1, Jishmaël van der Horst, Fanny Pelzer
1Danique Heuvelings, MD, is Medical Doctor and Surgical PhD Candidate, Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands, and NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University. Also at Department of Surgery, Maastricht University Medical Center, Jishmaël van der Horst, MD, is Clinical Specialist, and Fanny Pelzer, MD, is Wound Care Nurse. Frits Aarts, MD, PhD, is Oncological Surgeon, Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands. Sanne Engelen, MD, PhD, is Oncological Surgeon, Department of Surgery, Maastricht University Medical Center.
Massive localized lymphedema (MLL) is a benign tumor often mistaken for sarcoma. For high-risk patients, less invasive treatments like maggot therapy and negative-pressure wound therapy offer a viable alternative to surgery.
Area of Science:
- Dermatology
- Surgical Oncology
- Wound Care
Background:
- Massive localized lymphedema (MLL) is a benign lymphoproliferative overgrowth, predominantly seen in individuals with severe obesity (Class III).
- MLL often presents as a painless, long-standing mass, frequently mistaken for sarcoma due to similar clinical presentation.
- Patients typically seek medical attention when MLL interferes with daily activities, leading to potential complications like infections.
Purpose of the Study:
- To present a case of Massive localized lymphedema (MLL) in a severely obese patient.
- To highlight the challenges in diagnosing and managing MLL, particularly its resemblance to sarcoma.
- To evaluate the efficacy of a minimally invasive treatment approach for MLL in a high-risk patient.
Main Methods:
- The study details the management of a 47-year-old female patient with a BMI of 73 kg/m2 presenting with MLL of the right medial thigh.
- Treatment involved a combination of local necrosectomy, wound debridement, maggot debridement therapy (MDT), and negative-pressure wound therapy (NPWT) using a vacuum-assisted closure (VAC) device.
- This approach was chosen due to the patient's high-risk profile for conventional surgical excision.
Main Results:
- The patient with Massive localized lymphedema (MLL) was successfully diagnosed and managed using the described multimodal, minimally invasive approach.
- The combination of maggot debridement therapy and negative-pressure wound therapy proved effective in treating the MLL and associated necrotic wounds.
- This case demonstrates the successful application of non-surgical interventions in a high-risk patient population.
Conclusions:
- Diagnosis of Massive localized lymphedema (MLL) can be challenging due to its similarity to sarcoma, and its pathogenesis/management require further elucidation.
- Surgical excision, while standard, poses significant risks for patients with Class III obesity and comorbidities.
- Nonsurgical management, including maggot debridement therapy followed by negative-pressure wound therapy, should be strongly considered for high-risk MLL patients with necrotic wounds and fluid loss.
