In lymphedema a build-up of adipose tissue occurs with the progression of the disease and is related to a situation of chronic lymph stasis. In some cases, patients have a marked tendency towards developing this fibrotic-adipose tissue in the affected limb (this tissue gives the thick and hard consistency present in advanced stages of lymphedema). Unfortunately this excess tissue actually impedes the flow of lymph further. It also provides the perfect breeding ground for infections, should a cut to the skin occur, because the lymph stasis means that the body can no longer effectively send antibodies via the lymphatic system where they are needed. This situation is emphasized in the lower limbs, as gravity makes the removal of fluid from the feet, ankles, and calves particularly difficult and therefore these areas show the greatest increase in excess tissue formation.

Recently, suction-assisted liposuction has been utilized as a minimally invasive procedure to remove excess adipose tissue. Given the existing poor lymph drainage in patients with lymphatic diseases, extra caution needs to be taken to avoid damaging the lymphatic vessels further during liposuction. Investigations of lymph vessels in cadavers after dry and tumescent liposuction showed that significant injury to tissues occurred with the movement of the cannula and noted that a tumescent procedure and a parallel approach was necessary to avoid injury in people with normal lymphatic systems. In patients with lymphedema, the lymph vessels and channels are often dilated and tortuous in the advanced stages of disease, which is exactly when liposuction is prescribed, and therefore may be more difficult to avoid with the liposuction cannula and more vulnerable to damage.

We have recently developed a new lympho-lipo-aspiration technique (Fibro-Lipo-Lymph-Aspiration (FLLA) with a Lymph Vessel Sparing Procedure (LVSP), Corrado Cesare Campisi) to improve the chronic swelling of patients with advanced lymphedema, taking a lymphatic sparing approach. Using blue patent violet (BPV), together with the photodynamic eye (PDE) method with indocyanine green (ICG) fluorescence, to highlight the lymphatic pathways in the limb, the excess adipose tissue is carefully aspirated.

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