PDF(Pubmed)
Abstract：
Lipedema is a progressive connective tissue disease with enlargement of adipose tissue, fibrosis, fluid collection, and dermal thickening. Herein, we present a case of lipedema associated with skin hypoperfusion and ulceration in which soft tissue debulking with liposuction improved patients\' symptoms. A 39-year-old female presented with asymmetric progressive initially unilateral lower limb swelling with severe pain with subsequent skin ulceration. Conservative management failed to improve her condition. After excluding other causes and detailed radiologic investigation, lipedema was diagnosed with an associated impaired skin perfusion. Trial of local wound care and compression therapy failed to improve the condition. Subsequent soft tissue debulking with circumferential liposuction and ulcer debridement and immediate compression showed dramatic improvement of the symptoms and skin perfusion. The unique nature of this case sheds light on lipedema as a loose connective tissue disease. Inflammation and microangiopathies explain the associated pain with hypoperfusion and ulceration being quite atypical and in part might be related to the large buildups of matrix proteins and sodium contents leading to fragility in microvessels with frequent petechiae and hematoma and subsequent tissue ischemia. Conservative measures like compression therapy plays a significant role in disease course. Surgical debulking with liposuction was shown to be efficacious in reducing the soft tissue load with improvement in limb pain, edema, circumference, and skin perfusion that was seen in our patient. Lipedema is a frequently misdiagnosed condition with disabling features. Skin involvement in lipedema with potential hypoperfusion was shown and it requires further investigation.
摘要：
脂水肿是一种进行性结缔组织疾病，伴有脂肪组织增大，纤维化，流体收集,和真皮增厚。在这里，我们介绍了一例与皮肤灌注不足和溃疡相关的脂肪水肿，其中通过吸脂术使软组织减积改善了患者的症状。一名39岁的女性出现不对称的进行性最初的单侧下肢肿胀，并伴有严重的疼痛，随后出现皮肤溃疡。保守的管理未能改善她的状况。排除其他原因并进行详细的放射学检查后，脂水肿被诊断为相关的皮肤灌注受损。局部伤口护理和压迫疗法的试验未能改善病情。随后通过圆周吸脂术和溃疡清创术以及立即压迫进行的软组织减积显示出症状和皮肤灌注的显着改善。这种情况的独特性质揭示了作为疏松结缔组织疾病的脂水肿。炎症和微血管病变解释了与低灌注和溃疡相关的疼痛非常不典型，部分可能与基质蛋白和钠含量的大量积累有关，导致微血管脆性，伴有频繁的瘀点和血肿以及随后的组织缺血。保守措施如压迫治疗在病程中起着重要作用。手术减积与吸脂术被证明是有效的，在减少软组织负荷和改善四肢疼痛，水肿,周长,和我们病人的皮肤灌注。脂水肿是一种经常误诊的疾病，具有残疾特征。已显示皮肤受累于伴有潜在的灌注不足，需要进一步研究。
