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.
Keywords
lipedema - hypoperfusion - liposuction - ulcer
